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Article(id=1322609077172154555, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506424, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750780800000, receivedDateStr=2025-06-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793264176885, onlineDateStr=2026-10-29, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793264176885, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793264176885, creator=13701087609, updateTime=1793264176885, updator=13701087609, issue=Issue{id=1322609030938346427, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793264165863, creator='13701087609', updateTime=1793264299902, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609593264489401, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609593264489402, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4156, endPage=4160, ext={EN=ArticleExt(id=1322609077360898236, articleId=1322609077172154555, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A prospective study on the association between loneliness and the risk of arthritis in middle-aged and older adults in China, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between loneliness and the risk of arthritis incidence among middle-aged and older adults in China.

Methods

Based on data from the China Health and Retirement Longitudinal Study（CHARLS）2011—2020, this study included 9 086 middle-aged and older adults who were free of arthritis at baseline. Participants were categorized into loneliness and non-loneliness groups according to Item 9 of the Center for Epidemiologic Studies Depression Scale（CES-D）. The Kaplan-Meier method was used to plot cumulative incidence curves, and Cox proportional hazards regression models were employed to assess the association between loneliness and incident arthritis risk.

Results

By December 1, 2020, the mean follow-up time was 8.1 years, a total of 1 808 incident arthritis cases were recorded during follow-up. The loneliness group exhibited an arthritis incidence density of 29.36 per 1 000 person-years, compared with 23.05 per 1 000 person-years in the non-loneliness group. The cumulative incidence rate of arthritis was significantly higher in the loneliness group compared to the non-loneliness group（χ2=31.849, P<0.001）. After adjusting for multiple confounders, participants in the loneliness group demonstrated a 26% increased risk of arthritis development compared with the non-loneliness group（HR=1.26, 95% CI: 1.14-1.40）. Subgroup analyses stratified by age, sex, residence, educational level, health insurance status, smoking status, alcohol consumption, BMI, physical activity level, and other chronic diseases revealed largely consistent findings.

Conclusion

In the middle-aged and older adult population in China, loneliness is significantly associated with an elevated risk of incident arthritis. Promoting social connectivity and implementing targeted interventions to mitigate loneliness may serve as effective strategies for arthritis prevention in this population.

, authors=Xi CHEN1, Zhuo-ma DEJI1, Xin YANG1, Rui-qi JIA1, Xin-yue LAI1, Meng-jie HU1, Yan-qiu ZOU1, Yan SU1, Xiao-xue LIU1, Xia JIANG1, 2, Jia-yuan LI1, 2, Meng-yu FAN1, 2, authorsList=Xi CHEN, Zhuo-ma DEJI, Xin YANG, Rui-qi JIA, Xin-yue LAI, Meng-jie HU, Yan-qiu ZOU, Yan SU, Xiao-xue LIU, Xia JIANG, Jia-yuan LI, Meng-yu FAN, authorCompany=null, correspAuthors=Meng-yu FAN, 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=1322609080229802184, articleId=1322609077172154555, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年人孤独感与关节炎发病风险关联的前瞻性研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中国中老年人群中孤独感与关节炎发病风险的关联。

方法

本研究基于2011—2020年中国健康与养老追踪调查的数据，以基线未患关节炎的9 086名人为对象，根据流行病学研究中心抑郁量表（CES-D）第9条目将对象分为孤独和非孤独组。采用Kaplan-Meier（K-M）法绘制累积发病曲线，采用Cox比例风险回归模型分析孤独感与关节炎发病风险之间的关联。

结果

截至2020年12月1日，平均随访8.1年，随访期间共观察到关节炎发病1 808例。孤独组关节炎发病密度为29.36/1 000人年，非孤独组关节炎发病密度为23.05/1 000人年，孤独组累计发病率显著高于非孤独组（χ2=31.849，P<0.001）。在调整多种混杂因素后，与非孤独组相比，孤独组发生关节炎的风险增加了26%（HR=1.26，95% CI: 1.14~1.40）。按年龄、性别、居住地、文化程度、医保情况、吸烟状况、饮酒状况、BMI、体力活动水平、其他慢性疾病等进行亚组分析，上述结果基本不变。

结论

在我国中老年人群中，孤独感与关节炎的发病风险增加相关。保持健康的社会联系、降低中老年人群的孤独感有助于预防关节炎的发生。

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陈曦和的机卓玛为共同第一作者。

陈曦（2002—），女，本科在读，研究方向:慢性流行病学；

的机卓玛（1999—），女，硕士在读，研究方向:慢性流行病学

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樊萌语，E-mail：
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Journal of Ginseng Research, 2017, 41 (4): 589-594., articleTitle=Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis, refAbstract=null)], funds=[Fund(id=1322609095148941605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, awardId=YJ202455, language=CN, fundingSource=四川大学引进人才科研启动经费(YJ202455), fundOrder=null, country=null), Fund(id=1322609095438348582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, awardId=2024NSFTD0030, language=CN, fundingSource=四川省科技厅创新研究群体(2024NSFTD0030), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322609080544374985, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, xref=1., ext=[AuthorCompanyExt(id=1322609080573735114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, companyId=1322609080544374985, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1322609080586318027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, companyId=1322609080544374985, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/四川大学华西第四医院，四川　成都　610041)]), AuthorCompany(id=1322609080649232588, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, xref=2., ext=[AuthorCompanyExt(id=1322609080657621197, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, companyId=1322609080649232588, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院/四川大学华西第四医院重大疾病医防融合研究所)])], figs=[ArticleFig(id=1322609092615581981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=EN, label=Fig.1, caption=Cumulative incidence curves, figureFileSmall=3LNUJcFTnaIX0fQGwEBLvQ==, figureFileBig=HFA0YfEAd3Se1pFNk5Kt1w==, tableContent=null), ArticleFig(id=1322609093769015582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=CN, label=图1, caption=累积发病率曲线, figureFileSmall=3LNUJcFTnaIX0fQGwEBLvQ==, figureFileBig=HFA0YfEAd3Se1pFNk5Kt1w==, tableContent=null), ArticleFig(id=1322609094184251679, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=EN, label=Fig.2, caption=Subgroup analysis between loneliness and incident arthritis risk（n=9 086）, figureFileSmall=YE6e/7wNuawc3VTTJWaiPg==, figureFileBig=Ksjtl8cHJItWYIIkYEs7WA==, tableContent=null), ArticleFig(id=1322609094272332064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=CN, label=图2, caption=孤独感与关节炎发病风险的亚组分析（n=9 086）

注：图中分析以非孤独组为参照组，报告孤独组发生关节炎的风险效应值。模型中调整因素详见表2下注释，同模型3调整。

, figureFileSmall=YE6e/7wNuawc3VTTJWaiPg==, figureFileBig=Ksjtl8cHJItWYIIkYEs7WA==, tableContent=null), ArticleFig(id=1322609094607876385, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=EN, label=Table 1, caption=

Baseline characteristics of the study participants

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人群
（n=9 086）		非孤独组
（n=6 838）		孤独组
（n=2 248）		χ2/Z值P值
年龄（岁，）58.6±9.658.2±9.459.8±10.0-6.867<0.001
性别[n（%）]69.152<0.001
男4 650（51.2）3 671（53.7）979（43.5）
女4 436（48.8）3 167（46.3）1 269（56.5）
居住地[n（%）]62.206<0.001
农村5 286（58.0）3 804（55.6）1 464（65.1）
城镇3 818（42.0）3 034（44.4）784（34.9）
文化程度[n（%）]85.576<0.001
未上过学3 677（40.5）2 580（37.7）1 097（48.8）
小学及以上5 509（59.5）4 258（62.3）1 151（51.2）
医保[n（%）]4.7780.029
有8 521（93.8）6 435（94.1）2 086（92.8）
无565（6.2）403（5.9）162（7.2）
吸烟状况[n（%）]6.9010.009
吸烟2 918（32.1）2 247（32.9）671（29.8）
戒烟/不吸烟6 168（67.9）4 591（67.1）1 577（70.2）
饮酒状况[n（%）]30.391<0.001
饮酒3 121（34.3）2 457（35.9）664（29.5）
不饮酒5 965（65.7）4 381（64.1）1 584（70.5）
BMI（kg/m2，）23.4±3.923.5±3.823.1±3.94.289<0.001
体力活动水平[n（%）]2.1450.342
低5 976（65.8）4 470（65.4）1 506（67.0）
中737（8.1）557（8.1）180（8.0）
高2 373（26.1）1 811（26.5）562（25.0）
高血压[n（%）]5.7730.016
有2 105（23.2）1 542（22.6）563（25.0）
无6 981（76.8）5 296（77.4）1 685（75.0）
糖尿病[n（%）]0.2640.608
有488（5.4）362（5.3）126（5.6）
无8 598（94.6）6 476（94.7）2 122（94.4）
血脂异常[n（%）]0.1710.680
有822（9.0）624（9.1）198（8.8）
无8 264（91.0）6 214（90.9）2 050（91.2）
a其他慢性疾病[n（%）]63.180<0.001
有3 307（36.4）2 331（34.2）976（43.4）
无5 779（63.6）4 507（65.8）1 272（56.6）
降压治疗[n（%）]5.5360.063
有496（5.5）365（5.3）131（5.8）
无1 599（17.6）1 171（17.1）428（19.0）
不患高血压6 991（76.9）5 302（77.5）1 689（75.1）
降糖治疗[n（%）]2.3910.303
有128（1.4）89（1.3）39（1.7）
无351（3.9）267（3.9）84（3.7）
不患糖尿病8 607（94.7）6 482（94.8）2 125（94.5）
降脂治疗[n（%）]0.1590.923
有376（4.1）285（4.2）91（4.0）
无431（4.7）327（4.8）104（4.6）
不患血脂异常8 279（91.1）6 226（91.1）2 053（91.3）
社交隔离[n（%）]85.924<0.001
有3 168（34.9）2 202（32.2）966（43.0）
无5 918（65.1）4 636（67.8）1 282（57.0）
), ArticleFig(id=1322609094687568162, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=CN, label=表1, caption=

研究对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总人群
（n=9 086）		非孤独组
（n=6 838）		孤独组
（n=2 248）		χ2/Z值P值
年龄（岁，）58.6±9.658.2±9.459.8±10.0-6.867<0.001
性别[n（%）]69.152<0.001
男4 650（51.2）3 671（53.7）979（43.5）
女4 436（48.8）3 167（46.3）1 269（56.5）
居住地[n（%）]62.206<0.001
农村5 286（58.0）3 804（55.6）1 464（65.1）
城镇3 818（42.0）3 034（44.4）784（34.9）
文化程度[n（%）]85.576<0.001
未上过学3 677（40.5）2 580（37.7）1 097（48.8）
小学及以上5 509（59.5）4 258（62.3）1 151（51.2）
医保[n（%）]4.7780.029
有8 521（93.8）6 435（94.1）2 086（92.8）
无565（6.2）403（5.9）162（7.2）
吸烟状况[n（%）]6.9010.009
吸烟2 918（32.1）2 247（32.9）671（29.8）
戒烟/不吸烟6 168（67.9）4 591（67.1）1 577（70.2）
饮酒状况[n（%）]30.391<0.001
饮酒3 121（34.3）2 457（35.9）664（29.5）
不饮酒5 965（65.7）4 381（64.1）1 584（70.5）
BMI（kg/m2，）23.4±3.923.5±3.823.1±3.94.289<0.001
体力活动水平[n（%）]2.1450.342
低5 976（65.8）4 470（65.4）1 506（67.0）
中737（8.1）557（8.1）180（8.0）
高2 373（26.1）1 811（26.5）562（25.0）
高血压[n（%）]5.7730.016
有2 105（23.2）1 542（22.6）563（25.0）
无6 981（76.8）5 296（77.4）1 685（75.0）
糖尿病[n（%）]0.2640.608
有488（5.4）362（5.3）126（5.6）
无8 598（94.6）6 476（94.7）2 122（94.4）
血脂异常[n（%）]0.1710.680
有822（9.0）624（9.1）198（8.8）
无8 264（91.0）6 214（90.9）2 050（91.2）
a其他慢性疾病[n（%）]63.180<0.001
有3 307（36.4）2 331（34.2）976（43.4）
无5 779（63.6）4 507（65.8）1 272（56.6）
降压治疗[n（%）]5.5360.063
有496（5.5）365（5.3）131（5.8）
无1 599（17.6）1 171（17.1）428（19.0）
不患高血压6 991（76.9）5 302（77.5）1 689（75.1）
降糖治疗[n（%）]2.3910.303
有128（1.4）89（1.3）39（1.7）
无351（3.9）267（3.9）84（3.7）
不患糖尿病8 607（94.7）6 482（94.8）2 125（94.5）
降脂治疗[n（%）]0.1590.923
有376（4.1）285（4.2）91（4.0）
无431（4.7）327（4.8）104（4.6）
不患血脂异常8 279（91.1）6 226（91.1）2 053（91.3）
社交隔离[n（%）]85.924<0.001
有3 168（34.9）2 202（32.2）966（43.0）
无5 918（65.1）4 636（67.8）1 282（57.0）
), ArticleFig(id=1322609094763065635, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=EN, label=Table 2, caption=

Association between loneliness and incident arthritis risk（n=9 086）

, figureFileSmall=null, figureFileBig=null, tableContent=
调整模型发病人数发病密度
（1/1 000人年）		HR（95% CI）P值
模型1<0.001
非孤独1 28223.051.00
孤独52629.361.30（1.17~1.43）
模型2<0.001
非孤独1 28223.051.00
孤独52629.361.27（1.15~1.41）
模型3<0.001
非孤独1 28223.051.00
孤独52629.361.26（1.14~1.40）
), ArticleFig(id=1322609095035695396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609077172154555, language=CN, label=表2, caption=

孤独感与关节炎发病风险的关联分析（n=9 086）

, figureFileSmall=null, figureFileBig=null, tableContent=
调整模型发病人数发病密度
（1/1 000人年）		HR（95% CI）P值
模型1<0.001
非孤独1 28223.051.00
孤独52629.361.30（1.17~1.43）
模型2<0.001
非孤独1 28223.051.00
孤独52629.361.27（1.15~1.41）
模型3<0.001
非孤独1 28223.051.00
孤独52629.361.26（1.14~1.40）
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中国中老年人孤独感与关节炎发病风险关联的前瞻性研究
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陈曦 1 , 的机卓玛 1 , 杨昕 1 , 贾瑞起 1 , 赖欣玥 1 , 胡梦婕 1 , 邹雁秋 1 , 苏颜 1 , 刘小雪 1 , 姜侠 1, 2 , 李佳圆 1, 2 , 樊萌语 1, 2
现代预防医学 | 健康与社会行为 2025,52(22): 4156-4160
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现代预防医学 |健康与社会行为 2025 , 52 (22) : 4156 -4160
中国中老年人孤独感与关节炎发病风险关联的前瞻性研究
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陈曦1, 的机卓玛1, 杨昕1, 贾瑞起1, 赖欣玥1, 胡梦婕1, 邹雁秋1, 苏颜1, 刘小雪1, 姜侠1, 2, 李佳圆1, 2, 樊萌语1, 2
作者信息
  • 1.四川大学华西公共卫生学院/四川大学华西第四医院，四川　成都　610041
  • 2.四川大学华西公共卫生学院/四川大学华西第四医院重大疾病医防融合研究所
通讯作者:
樊萌语，E-mail：
作者简介:

陈曦和的机卓玛为共同第一作者。

陈曦（2002—），女，本科在读，研究方向:慢性流行病学；

的机卓玛（1999—），女，硕士在读，研究方向:慢性流行病学

A prospective study on the association between loneliness and the risk of arthritis in middle-aged and older adults in China
Xi CHEN1, Zhuo-ma DEJI1, Xin YANG1, Rui-qi JIA1, Xin-yue LAI1, Meng-jie HU1, Yan-qiu ZOU1, Yan SU1, Xiao-xue LIU1, Xia JIANG1, 2, Jia-yuan LI1, 2, Meng-yu FAN1, 2
Affiliations
  • West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-11-25 doi: 10.20043/j.cnki.MPM.202506424
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摘要
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目的

探讨中国中老年人群中孤独感与关节炎发病风险的关联。

方法

本研究基于2011—2020年中国健康与养老追踪调查的数据，以基线未患关节炎的9 086名人为对象，根据流行病学研究中心抑郁量表（CES-D）第9条目将对象分为孤独和非孤独组。采用Kaplan-Meier（K-M）法绘制累积发病曲线，采用Cox比例风险回归模型分析孤独感与关节炎发病风险之间的关联。

结果

截至2020年12月1日，平均随访8.1年，随访期间共观察到关节炎发病1 808例。孤独组关节炎发病密度为29.36/1 000人年，非孤独组关节炎发病密度为23.05/1 000人年，孤独组累计发病率显著高于非孤独组（χ2=31.849，P<0.001）。在调整多种混杂因素后，与非孤独组相比，孤独组发生关节炎的风险增加了26%（HR=1.26，95% CI: 1.14~1.40）。按年龄、性别、居住地、文化程度、医保情况、吸烟状况、饮酒状况、BMI、体力活动水平、其他慢性疾病等进行亚组分析，上述结果基本不变。

结论

在我国中老年人群中，孤独感与关节炎的发病风险增加相关。保持健康的社会联系、降低中老年人群的孤独感有助于预防关节炎的发生。

孤独感  /  关节炎  /  中老年人  /  前瞻性队列研究
Objective

To investigate the association between loneliness and the risk of arthritis incidence among middle-aged and older adults in China.

Methods

Based on data from the China Health and Retirement Longitudinal Study（CHARLS）2011—2020, this study included 9 086 middle-aged and older adults who were free of arthritis at baseline. Participants were categorized into loneliness and non-loneliness groups according to Item 9 of the Center for Epidemiologic Studies Depression Scale（CES-D）. The Kaplan-Meier method was used to plot cumulative incidence curves, and Cox proportional hazards regression models were employed to assess the association between loneliness and incident arthritis risk.

Results

By December 1, 2020, the mean follow-up time was 8.1 years, a total of 1 808 incident arthritis cases were recorded during follow-up. The loneliness group exhibited an arthritis incidence density of 29.36 per 1 000 person-years, compared with 23.05 per 1 000 person-years in the non-loneliness group. The cumulative incidence rate of arthritis was significantly higher in the loneliness group compared to the non-loneliness group（χ2=31.849, P<0.001）. After adjusting for multiple confounders, participants in the loneliness group demonstrated a 26% increased risk of arthritis development compared with the non-loneliness group（HR=1.26, 95% CI: 1.14-1.40）. Subgroup analyses stratified by age, sex, residence, educational level, health insurance status, smoking status, alcohol consumption, BMI, physical activity level, and other chronic diseases revealed largely consistent findings.

Conclusion

In the middle-aged and older adult population in China, loneliness is significantly associated with an elevated risk of incident arthritis. Promoting social connectivity and implementing targeted interventions to mitigate loneliness may serve as effective strategies for arthritis prevention in this population.

Loneliness  /  Arthritis  /  Middle-aged and older adults  /  Prospective cohort study
陈曦, 的机卓玛, 杨昕, 贾瑞起, 赖欣玥, 胡梦婕, 邹雁秋, 苏颜, 刘小雪, 姜侠, 李佳圆, 樊萌语. 中国中老年人孤独感与关节炎发病风险关联的前瞻性研究. 现代预防医学, 2025 , 52 (22) : 4156 -4160 . DOI: 10.20043/j.cnki.MPM.202506424
Xi CHEN, Zhuo-ma DEJI, Xin YANG, Rui-qi JIA, Xin-yue LAI, Meng-jie HU, Yan-qiu ZOU, Yan SU, Xiao-xue LIU, Xia JIANG, Jia-yuan LI, Meng-yu FAN. A prospective study on the association between loneliness and the risk of arthritis in middle-aged and older adults in China[J]. Modern Preventive Medicine, 2025 , 52 (22) : 4156 -4160 . DOI: 10.20043/j.cnki.MPM.202506424
正文
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关节炎（Arthritis）是以关节和周围组织炎症为病理特征的一类疾病的总称，是导致慢性疼痛和残疾的主要病因之一[1-2]。随着人口老龄化加剧，关节炎相关疾病负担持续攀升[3-5]，现已成为70岁以上人群伤残调整寿命年的第七大诱因[6]。除年龄[7-8]、肥胖[9-10]等危险因素外，有研究提示心理社会因素可能通过炎症反应影响关节炎的发生发展[11-12]。孤独感（Loneliness）是个体期望的社会联系水平与实际的社会联系水平之间的差异所引发的主观痛苦感受[13]，是近年慢性病病因研究的新热点。在中国，随着老龄化加速，孤独感在中老年人群中普遍存在，作为一种可干预的心理社会因素，其与关节炎发病的关联尚未完全明晰，且缺乏中国本土的高质量证据。本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）纵向数据，探讨孤独感与我国中老年人群关节炎发病风险的关联。
1　对象与方法
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1.1　研究对象
本研究数据源自中国健康与养老追踪调查（CHARLS）。该队列采用多阶段概率抽样，于2011—2012年选取全国28个省级行政区的17 000余名受访者完成基线调查，随后在2013、2015、2018及2020年进行了4次随访调查。项目的详细介绍可参见文献[14]。在参与基线调查的17 705名调查对象中，本研究剔除了孤独感信息缺失者（n=1 783）、基线患有关节炎者（n=5 349）、年龄和性别信息缺失者（n=7）、基线调查后失访者（n=1 251）、发病日期缺失者（n=1）、年龄<45岁者（n=228）。最终有9 086人纳入分析。
1.2　研究内容
1.2.1　孤独感的测量
调查对象的孤独感通过流行病学研究中心抑郁量表（Center for Epidemiological Studies Depression Scale, CES-D）的第9条目进行评价[15]。该条目通过结构化问题“过去的这一周里，你多久会感到孤独？”进行测量，选项分别有：1=很少或者根本没有（<1天）、2=不太多（1~2天）、3=有时或者有一半的时间（3~4天）、4=大多数的时间（5~7天）。基于既往研究对孤独感的二分法分类策略[16]，本研究将回答选项1的受访者纳入非孤独组，将回答其余选项的受访者纳入孤独组。
1.2.2　结局评估
关节炎的发病信息通过随访问卷中健康功能与状况部分的三个问题获取：是否有医生诊断过关节炎、是否正在接受关节炎治疗、以及是如何得知关节炎诊断的（包括生病后体检、发作后体检、常规体检、CHARLS体检或其他方式）。上述任一问题回答“是”的受访者即被视为关节炎发病。
1.2.3　协变量
本研究纳入分析的协变量包括：年龄、性别、居住地、医保、吸烟状况、饮酒状况、体力活动水平、身体质量指数（Body Mass Index，BMI）、高血压、糖尿病、血脂异常、降压治疗、降糖治疗、降脂治疗、现患其他慢性疾病情况和社交隔离状况。体力活动水平通过计算一周的代谢当量（Metabolic Equivalent，MET）水平进行分组：低（<600 MET/周）、中（600~3 000 MET/周）、高（>3 000 MET/周）[17]。参考既往研究，社交隔离通过基线问卷中的四个维评估：①未婚（包括分居、离婚、丧偶或从未结过婚）；②独居；③每周与子女联系少于一次；④近一个月未参与任何社交活动。
1.3　统计分析
采用R 4.4.2软件进行数据分析，所有检验为双侧检验，显著性水平α=0.05。连续型变量采用表示，分类变量采用构成比（%）表示，组间差异采用方差分析或χ2检验。采用Kaplan-Meier法绘制累积发病曲线，Log-rank检验比较孤独组与非孤独组关节炎发病的差异。随访人年的计算自基线调查完成时开始，到关节炎发病、死亡、失访或第四轮调查结束为止。采用Cox比例风险回归模型分析孤独感与关节炎发病之间的关联，计算风险比（Hazard ratio, HR）及其95%可信区间（Confidence interval, CI），并对已知或可能影响关节炎发病的因素进行了分步调整。模型1调整了年龄和性别（男、女）；模型2在模型1基础上调整了居住地（城市、农村）、文化程度（未上过学、小学及以上）、医保（有、无）、吸烟状况（吸烟、戒烟/不吸烟）、饮酒状况（饮酒、不饮酒）、BMI（kg/m2）、体力活动水平（低、中、高）；模型3在模型2基础上调整了高血压（有、无）、糖尿病（有、无）、血脂异常（有、无）、降压治疗（有、无）、降糖治疗（有、无）、降脂治疗（有、无）、现患慢性疾病情况（有、无）和社交隔离状况（有、无）。此外，根据研究对象的基线特征分层，并在模型中加入暴露因素与分层因素的交互项，对交互项的回归系数进行检验，以探究孤独感与关节炎发病风险的关联在不同人群中是否一致。为保证结果的稳健性，排除第一次随访发生关节炎的个体进行敏感性分析。
2　结果
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2.1　研究对象一般情况
共纳入9 086名研究对象，年龄为（58.6±9.6）岁，男性占51.2%（4 650名），自报孤独者占24.7%（2 248名）。与非孤独组相比，孤独组年龄更大，女性、居住在农村、未上过学、没有医保、不吸烟、不饮酒、有高血压、有其他慢性疾病、社交隔离的比例更大，BMI更低（P<0.05），表1。
2.2　孤独感与关节炎的关联分析
平均随访8.1年，累计随访73 557.5人年。随访期间共观察到新发关节炎1 808例，发病密度为24.6/1 000人年。孤独组关节炎发病密度为29.36/1 000人年，非孤独组关节炎发病密度为23.05/1 000人年，孤独组关节炎发病密度高于非孤独组，差异有统计学意义（P<0.001）。在调整社会人口学因素、生活方式、个人健康状况等多种混杂因素后，与非孤独组相比，孤独组发生关节炎的风险增加26%（HR=1.26，95% CI: 1.14~1.40）。见表2、图1。
2.3　亚组分析
体力活动对孤独与关节炎发病风险间的关联具有效应修饰作用（交互作用P<0.05）。其余各亚组对孤独感与关节炎发病风险的关联间无效应修饰作用（交互作用P>0.05）。见图2。
2.4　敏感性分析
剔除了第一次随访发生关节炎的686名研究对象后，孤独感与关节炎发病风险的关联未见明显改变（结果未展示）。
3　讨论
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本研究利用CHARLS队列10年随访数据，前瞻性分析了我国中老年人群孤独感与关节炎发病风险之间的关联。结果显示，在调整了社会人口学因素、生活方式、个人健康状况等多种混杂因素后，与非孤独者相比，孤独者发生关节炎的风险增加26%。与既往国外队列研究一致[16,18-20]。2025年一项基于UKB队列纳入448 920名研究对象的队列研究结果显示，孤独感评分越高，骨关节炎的发病风险越大（HR=1.51，95% CI：1.39~1.63）[18]。另一项同样基于UKB的队列研究发现，孤独者发生类风湿性关节炎的风险比非孤独者增加了22%（HR=1.22，95% CI：1.11~1.34）[16]。孤独感与关节炎之间的生物学机制尚未阐明。有研究提示孤独感可能通过炎症反应影响关节炎的发生[21]。一项纳入美国927名35~64岁参与者的研究发现，孤独者的三种全身炎症标志物（白细胞介素-6、纤维蛋白原、C反应蛋白）均显著升高[22]，而这三种炎症因子均是关节炎病理进展的重要生物学标志物[23-26]。此外，可溶性尿激酶纤溶酶原激活物受体（suPAR）作为一种新型慢性炎症标志物，被发现与孤独感[27]和关节炎[28]的活动度均呈正相关，提示其可能在二者之间起到潜在的中介作用。此外，孤独感还可能通过神经-内分泌机制介导关节炎的病理进程。研究发现，孤独感作为一种压力源，可能引起下丘脑-垂体-肾上腺轴（HPA轴）的失调，从而加剧关节组织的氧化应激损伤[29-31]。
本研究为前瞻性队列设计，随访时间较长，证据等级较高。CHARLS队列4轮随访应答率均高于80%，样本量大且覆盖范围广，外推性强。在敏感性分析时，本研究剔除了第一次随访时新发关节炎的研究对象，一定程度上避免了因果倒置的影响。此外，本研究控制了可能存在的混杂因素，最大限度地减少了混杂偏倚。
本研究存在一定的局限性。首先，本研究未考虑到随访期间研究对象孤独感的变化情况，未来研究可进一步探讨孤独感变化与关节炎发病之间的关联。其次，尽管研究中已经调整了已知的和可能的混杂因素，但受限于研究数据，不排除其他未测量或未知的混杂因素对结果的影响，比如关节炎家族史。
综上，本研究发现孤独感是关节炎发病的独立危险因素。在体重管理等传统防控措施的基础上，我国关节炎防控策略应同步关注社会心理维度，重视中老年人群社会联系网络构建及心理孤独症状的早期识别与干预。
基金
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  • 四川大学引进人才科研启动经费(YJ202455)
  • 四川省科技厅创新研究群体(2024NSFTD0030)
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2025年第52卷第22期
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doi: 10.20043/j.cnki.MPM.202506424
  • 接收时间：2025-06-25
  • 首发时间：2026-10-29
  • 出版时间：2025-11-25
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出版历史
  • 收稿日期：2025-06-25
基金
四川大学引进人才科研启动经费(YJ202455)
四川省科技厅创新研究群体(2024NSFTD0030)
作者信息
    1.四川大学华西公共卫生学院/四川大学华西第四医院，四川　成都　610041
    2.四川大学华西公共卫生学院/四川大学华西第四医院重大疾病医防融合研究所

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樊萌语，E-mail：
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202506424
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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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