Article(id=1323941372943802779, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202505111, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746806400000, receivedDateStr=2025-05-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793581820951, onlineDateStr=2026-11-02, pubDate=1765296000000, pubDateStr=2025-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793581820951, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793581820951, creator=13701087609, updateTime=1793581820951, updator=13701087609, issue=Issue{id=1323941237702668764, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='23', pageStart='4225', pageEnd='4416', issueExtLink='null', onlineDate='null', pubDate='1765296000000', pubDateStr='2025-12-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793581788707, creator='13701087609', updateTime=1793581887795, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1323941653374959780, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1323941653374959781, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1323941237702668764, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4371, endPage=4376, ext={EN=ArticleExt(id=1323941373627474332, articleId=1323941372943802779, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The roles of social support and lifestyle habits in the association between number of living children and dementia among older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between the number of living children and dementia among older adults, as well as the influence of social support and lifestyle on this association.

Methods

This study included 6 232 participants aged ≥65 years from the Hubei Memory and Aging Cohort, categorized by number of living children (0, 1-2, ≥3). Multivariable logistic regression was used to analyze the associations with dementia, stratified by residence, sex, education level, and personal monthly income, while also examining the modifying effects of social support and lifestyle habits.

Results

Compared to older adults with 1-2 living children, those with no living children (OR=1.705, 95% CI: 1.205-2.412) and ≥3 living children (OR=1.344, 95% CI:1.030-1.753) had an increased risk of dementia. Stratified analysis revealed that compared with elderly people with 1-2 living children, those without living children in rural areas (OR=2.392, 95% CI: 1.544-3.707), males (OR=2.013, 95% CI: 1.190-3.404), females (OR=1.854, 95% CI: 1.094-3.144), those with low education levels (OR=1.859, 95% CI: 1.278-2.702), and those with low personal monthly income (OR=1.802, 95% CI: 1.211-2.682) had significantly higher risks of dementia. Among older adults with ≥3 living children, urban residents (OR=2.677, 95% CI: 1.557-4.603), males (OR=2.058, 95% CI: 1.259-3.363), those with higher education levels (OR=2.550, 95% CI: 1.298-5.009), and those with higher personal monthly income(OR=2.424, 95% CI: 1.096-5.361) all showed significantly elevated risks of dementia. Compared to older adults with poor social support and unhealthy lifestyles, the overall population with good social support (OR=0.569, 95% CI: 0.453-0.716) and healthy lifestyles (OR=0.485, 95% CI: 0.381-0.618) showed significantly lower dementia risk. Among childless older adults, those maintaining healthy lifestyles demonstrated even greater risk reduction (OR=0.515, 95% CI: 0.276-0.960). Among those with ≥3 living children, both good social support (OR=0.410, 95% CI: 0.306-0.549) and healthy lifestyles (OR=0.419, 95% CI: 0.307-0.573) were associated with the most substantial protective effects against dementia.

Conclusion

Older adults with no living children or ≥3 living children had significantly higher dementia risk compared to those with 1-2 living children. Compared with the elderly with 1-2 living children, the elderly in rural areas, males, females, with low education levels and low monthly personal income without living children, and urban elderly with ≥3 living children, males, and those with higher education levels and high monthly personal income had a higher risk of developing dementia. Good social support and healthy living habits were associated with a lower risk of dementia in the ungrouped population and elderly people with multiple children. Moreover,healthy living habits were also associated with a lower risk of dementia in the elderly without living children. No significant association was observed among those with 1-2 living children.

, authors=Xiao-lan ZHAO1, 2, 3, Dong-xi WANG1, 2, 3, Gui-rong CHENG1, 2, 3, Peng ZHANG4, Rui LI5, Zhao-lan HUANG6, authorsList=Xiao-lan ZHAO, Dong-xi WANG, Gui-rong CHENG, Peng ZHANG, Rui LI, Zhao-lan HUANG, authorCompany=null, correspAuthors=Zhao-lan HUANG, 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=1323941374927708573, articleId=1323941372943802779, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=社会支持和生活习惯在老年人健在子女个数与痴呆关联中的作用, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨老年人健在子女个数与痴呆的关联性,以及社会支持和生活方式对该关联的影响。

方法

选取湖北老年记忆队列6 232名≥65岁老年人,按健在子女个数分组(0个、1~2个和≥3个);采用多因素logistic回归分析其与痴呆的关联,进行城乡、性别、受教育程度及个人月收入分层分析,并探讨社会支持和生活方式对该关联的影响。

结果

相较于有1~2个健在子女的老年人,无健在子女(OR=1.705,95% CI: 1.205~2.412)和≥3个健在子女(OR=1.344,95% CI:1.030~1.753)的老年人痴呆患病风险均升高。分层分析显示:相较于有1~2个健在子女的老年人,无健在子女的农村(OR=2.392,95% CI: 1.544~3.707)、男性(OR=2.013,95% CI: 1.190~3.404)、女性(OR=1.854,95% CI: 1.094~3.144)、低受教育水平(OR=1.859,95% CI: 1.278~2.702)和低个人月收入(OR=1.802,95% CI: 1.211~2.682)老年人的痴呆患病风险更高;健在子女个数≥3个的城市(OR=2.677,95% CI: 1.557~4.603)、男性(OR=2.058,95% CI: 1.259~3.363)、高受教育水平(OR=2.550,95% CI: 1.298~5.009)和高个人月收入(OR=2.424,95% CI: 1.096~5.361)老年人的痴呆患病风险均更高。与社会支持差、生活习惯差的老年人相比,未分组中社会支持好(OR=0.569,95% CI: 0.453~0.716)、生活习惯好(OR=0.485,95% CI: 0.381~0.618)老年人的痴呆患病风险较低;无健在子女的老年人中,生活习惯好(OR=0.515,95% CI: 0.276~0.960)老年人的痴呆患病风险更低;健在子女≥3个的老年人中,社会支持好(OR=0.410,95% CI: 0.306~0.549)、生活习惯好(OR=0.419,95% CI: 0.307~0.573)老年人的痴呆患病风险均更低。

结论

健在子女个数为0或≥3个比1~2个的老年人痴呆患病风险均升高;与1~2个健在子女的老年人相比,无健在子女的农村、男性、女性、低受教育水平和低个人月收入老年人和≥3个健在子女的城市、男性、高受教育水平和高个人月收入老年人的痴呆患病风险均更高;良好的社会支持和健康的生活习惯与未分组及多子女老年人较低的痴呆患病风险有关,且健康生活习惯也与无健在子女老年人较低的痴呆患病风险有关,但在1~2个健在子女的人群中,未发现显著关联。

, authors=赵晓兰1, 2, 3, 王冬喜1, 2, 3, 程桂荣1, 2, 3, 张鹏4, 李锐5, 黄招兰6, authorsList=赵晓兰, 王冬喜, 程桂荣, 张鹏, 李锐, 黄招兰, authorCompany=null, correspAuthors=黄招兰, authorNote=

赵晓兰 (1990—) ,女,硕士在读,主管护师,研究方向:老年认知功能障碍

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黄招兰,E-mail:
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The relationship between lifestyle and mild cognitive impairment in the elderly [J]. Chinese Journal of Gerontology, 2021, 41 (3): 665-669. (In Chinese), articleTitle=The relationship between lifestyle and mild cognitive impairment in the elderly, refAbstract=null), Reference(id=1323941391310660100, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, doi=null, pmid=null, pmcid=null, year=2021, volume=18, issue=16, pageStart=8841, pageEnd=null, url=null, language=null, rfNumber=[26], rfOrder=32, authorNames=Pais R, Ruano L, Moreira C, journalName=International Journal of Environmental Research and Public Health, refType=null, unstructuredReference=Pais R, Ruano L, Moreira C, et al. Social support and cognitive impairment: results from a Portuguese 4-Year prospective study [J]. International Journal of Environmental Research and Public Health, 2021, 18 (16): 8841., articleTitle=Social support and cognitive impairment: results from a Portuguese 4-Year prospective study, refAbstract=null)], funds=[Fund(id=1323941386474627555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, awardId=WX23B01, language=CN, fundingSource=武汉市医学科学研究项目(WX23B01), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1323941376286663071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=1., ext=[AuthorCompanyExt(id=1323941376563487136, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941376286663071, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Medical College, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China), AuthorCompanyExt(id=1323941376571875745, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941376286663071, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.武汉科技大学医学部,湖北 武汉 430065)]), AuthorCompany(id=1323941376752230818, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=2., ext=[AuthorCompanyExt(id=1323941377075192227, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941376752230818, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.武汉科技大学脑科学先进技术研究院,湖北 武汉 430065)]), AuthorCompany(id=1323941377146495396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=3., ext=[AuthorCompanyExt(id=1323941377154884005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941377146495396, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.湖北省阿尔茨海默病临床医学研究中心,武汉科技大学附属天佑医院,湖北 武汉 430064)]), AuthorCompany(id=1323941377213604262, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=4., ext=[AuthorCompanyExt(id=1323941377221992871, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941377213604262, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.武汉市武昌医院科教科)]), AuthorCompany(id=1323941377456873896, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=5., ext=[AuthorCompanyExt(id=1323941377465262505, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941377456873896, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.武汉市武昌医院肾病免疫科)]), AuthorCompany(id=1323941377561731498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, xref=6., ext=[AuthorCompanyExt(id=1323941377570120107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, companyId=1323941377561731498, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=6.武汉科技大学附属老年病医院,湖北 武汉 430065)])], figs=[ArticleFig(id=1323941385379914203, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=EN, label=Table 1, caption=

The characteristics of the participants [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量子女个数(个)χ2/H值P值
01~2≥3
年龄(岁)a71 (68,75)70 (67,74)75 (71,79)630.588<0.001
居住地1 613.108<0.001
农村348 (45.0)790 (22.4)1 514 (78.6)
城市425 (55.0)2 742 (77.6)413 (21.4)
性别136.646<0.001
男499 (64.6)1 549 (43.9)780 (40.5)
女274 (35.4)1 983 (56.1)1 147 (59.5)
教育程度1 623.524<0.001
小学及以下532 (68.8)854 (24.2)1 446 (75.0)
初中58 (7.5)943 (26.7)297 (15.4)
高中或中专167 (21.6)1 130 (32.0)151 (7.8)
大学及以上16 (2.1)605 (17.1)33 (1.7)
个人月收入(元)1 274.596
<3 000461(59.6)1 245(35.2)1 646(85.4)<0.001
≥3 000312(40.4)2 287(64.8)281(14.6)
社会支持538.834<0.001
好480 (62.1)3 253 (92.1)1 442 (74.8)
差293 (37.9)279 (7.9)485 (25.2)
生活习惯210.367<0.001
好617 (79.8)3 031 (85.8)1 337 (69.4)
差156 (20.2)501 (14.2)590 (30.6)
高血压28.104<0.001
是349 (45.1)1 842 (52.2)1 085 (56.3)
否424 (54.9)1 690 (47.8)842 (43.7)
高血脂53.451<0.001
是155 (20.1)99 (28.1)386 (20.0)
否618 (79.9)2 540 (71.9)1 541 (80.0)
冠心病22.284<0.001
是160 (20.7)558 (15.8)391 (20.3)
否613 (79.3)2 974 (84.2)1 536 (79.7)
脑血管病52.873<0.001
是175 (22.6)580 (16.4)466 (24.2)
否598 (77.4)2 952 (83.6)1 461 (75.8)
抑郁37.134<0.001
是29 (3.8)150 (4.2)152 (7.9)
否744 (96.2)3 382 (95.8)1 775 (92.1)
痴呆217.034<0.001
是75 (9.7)111 (3.1)265 (13.8)
否698 (90.3)3 421 (96.9)1 662 (86.2)
), ArticleFig(id=1323941385455411676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=CN, label=表1, caption=

参与者的基本特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量子女个数(个)χ2/H值P值
01~2≥3
年龄(岁)a71 (68,75)70 (67,74)75 (71,79)630.588<0.001
居住地1 613.108<0.001
农村348 (45.0)790 (22.4)1 514 (78.6)
城市425 (55.0)2 742 (77.6)413 (21.4)
性别136.646<0.001
男499 (64.6)1 549 (43.9)780 (40.5)
女274 (35.4)1 983 (56.1)1 147 (59.5)
教育程度1 623.524<0.001
小学及以下532 (68.8)854 (24.2)1 446 (75.0)
初中58 (7.5)943 (26.7)297 (15.4)
高中或中专167 (21.6)1 130 (32.0)151 (7.8)
大学及以上16 (2.1)605 (17.1)33 (1.7)
个人月收入(元)1 274.596
<3 000461(59.6)1 245(35.2)1 646(85.4)<0.001
≥3 000312(40.4)2 287(64.8)281(14.6)
社会支持538.834<0.001
好480 (62.1)3 253 (92.1)1 442 (74.8)
差293 (37.9)279 (7.9)485 (25.2)
生活习惯210.367<0.001
好617 (79.8)3 031 (85.8)1 337 (69.4)
差156 (20.2)501 (14.2)590 (30.6)
高血压28.104<0.001
是349 (45.1)1 842 (52.2)1 085 (56.3)
否424 (54.9)1 690 (47.8)842 (43.7)
高血脂53.451<0.001
是155 (20.1)99 (28.1)386 (20.0)
否618 (79.9)2 540 (71.9)1 541 (80.0)
冠心病22.284<0.001
是160 (20.7)558 (15.8)391 (20.3)
否613 (79.3)2 974 (84.2)1 536 (79.7)
脑血管病52.873<0.001
是175 (22.6)580 (16.4)466 (24.2)
否598 (77.4)2 952 (83.6)1 461 (75.8)
抑郁37.134<0.001
是29 (3.8)150 (4.2)152 (7.9)
否744 (96.2)3 382 (95.8)1 775 (92.1)
痴呆217.034<0.001
是75 (9.7)111 (3.1)265 (13.8)
否698 (90.3)3 421 (96.9)1 662 (86.2)
), ArticleFig(id=1323941385803538909, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=EN, label=Table 2, caption=

Logistic regression analysis of different numbers of living children and dementia

, figureFileSmall=null, figureFileBig=null, tableContent=
健在子女数(个)模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
1~21.0001.0001.000
03.312 (2.443~4.488)<0.0011.802 (1.287~2.522)<0.0011.705 (1.205~2.412)0.003
≥34.914 (3.908~6.180)<0.0011.357 (1.045~1.762)0.0221.344 (1.030~1.753)0.029
), ArticleFig(id=1323941385883230686, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=CN, label=表2, caption=

不同健在子女个数与痴呆的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
健在子女数(个)模型1模型2模型3
OR (95% CI)P值OR (95% CI)P值OR (95% CI)P值
1~21.0001.0001.000
03.312 (2.443~4.488)<0.0011.802 (1.287~2.522)<0.0011.705 (1.205~2.412)0.003
≥34.914 (3.908~6.180)<0.0011.357 (1.045~1.762)0.0221.344 (1.030~1.753)0.029
), ArticleFig(id=1323941385946145247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=EN, label=Table 3, caption=

Stratified logistic regression analysis of the number of living children and dementia by urban-rural residence, sex, education level,and personal monthly income

, figureFileSmall=null, figureFileBig=null, tableContent=
分层总人数 (%)不同健在子女个数[个,OR(95% CI)]
1~20≥3
居住地
农村2 652 (42.6)1.0002.392 (1.544~3.707)***1.046 (0.771~1.421)
城市3 580 (57.4)1.0001.126 (0.579~2.189)2.677 (1.557~4.603)***
性别
男2 828 (45.4)1.0002.013 (1.190~3.404)**2.058 (1.259~3.363)**
女3 404 (54.6)1.0001.854 (1.094~3.144)*1.066 (0.770~1.476)
受教育程度a
低2 832 (45.5)1.0001.859 (1.278~2.702)***1.183 (0.888~1.576)
高3 400 (54.5)1.0000.500 (0.113~2.201)2.550 (1.298~5.009)**
个人月收入b
低3 352(53.8)1.0001.802 (1.211~2.682)**1.206 (0.907~1.604)
高2 880(46.2)1.0001.874 (0.811~4.328)2.424 (1.096~5.361)*
), ArticleFig(id=1323941386034225632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=CN, label=表3, caption=

健在子女个数与痴呆的logistic回归分析(基于城乡、性别、受教育程度和个人月收入分层)

, figureFileSmall=null, figureFileBig=null, tableContent=
分层总人数 (%)不同健在子女个数[个,OR(95% CI)]
1~20≥3
居住地
农村2 652 (42.6)1.0002.392 (1.544~3.707)***1.046 (0.771~1.421)
城市3 580 (57.4)1.0001.126 (0.579~2.189)2.677 (1.557~4.603)***
性别
男2 828 (45.4)1.0002.013 (1.190~3.404)**2.058 (1.259~3.363)**
女3 404 (54.6)1.0001.854 (1.094~3.144)*1.066 (0.770~1.476)
受教育程度a
低2 832 (45.5)1.0001.859 (1.278~2.702)***1.183 (0.888~1.576)
高3 400 (54.5)1.0000.500 (0.113~2.201)2.550 (1.298~5.009)**
个人月收入b
低3 352(53.8)1.0001.802 (1.211~2.682)**1.206 (0.907~1.604)
高2 880(46.2)1.0001.874 (0.811~4.328)2.424 (1.096~5.361)*
), ArticleFig(id=1323941386277495265, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=EN, label=Table 4, caption=

Multivariable logistic regression analysis of the association between the number of living children and dementia among older adults: the role of social support and lifestyle

, figureFileSmall=null, figureFileBig=null, tableContent=
健在子女数量(个)总人数社会支持OR(95% CI)P值总人数生活习惯OR(95% CI)P值
未分组1 063社会支持差1.0001 247生活习惯差1.000
未分组5 169社会支持好0.569 (0.453~0.716)<0.0014 985生活习惯好0.485 (0.381~0.618)<0.001
0299社会支持差1.000156生活习惯差1.000
0474社会支持好0.827 (0.476~1.437)0.500617生活习惯好0.515 (0.276~0.960)0.037
1~2279社会支持差1.000501生活习惯差1.000
1~23 253社会支持好0.981 (0.586~1.642)0.9423 031生活习惯好0.686 (0.409~1.149)0.152
≥3485社会支持差1.000590生活习惯差1.000
≥31 442社会支持好0.410 (0.306~0.549)<0.0011 337生活习惯好0.419 (0.307~0.573)<0.001
), ArticleFig(id=1323941386352992738, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1323941372943802779, language=CN, label=表4, caption=

社会支持与生活方式对老年人健在子女个数与痴呆的多因素logistic回归分析

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健在子女数量(个)总人数社会支持OR(95% CI)P值总人数生活习惯OR(95% CI)P值
未分组1 063社会支持差1.0001 247生活习惯差1.000
未分组5 169社会支持好0.569 (0.453~0.716)<0.0014 985生活习惯好0.485 (0.381~0.618)<0.001
0299社会支持差1.000156生活习惯差1.000
0474社会支持好0.827 (0.476~1.437)0.500617生活习惯好0.515 (0.276~0.960)0.037
1~2279社会支持差1.000501生活习惯差1.000
1~23 253社会支持好0.981 (0.586~1.642)0.9423 031生活习惯好0.686 (0.409~1.149)0.152
≥3485社会支持差1.000590生活习惯差1.000
≥31 442社会支持好0.410 (0.306~0.549)<0.0011 337生活习惯好0.419 (0.307~0.573)<0.001
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社会支持和生活习惯在老年人健在子女个数与痴呆关联中的作用
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赵晓兰 1, 2, 3 , 王冬喜 1, 2, 3 , 程桂荣 1, 2, 3 , 张鹏 4 , 李锐 5 , 黄招兰 6
现代预防医学 | 健康与社会行为 2025,52(23): 4371-4376
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现代预防医学 |健康与社会行为 2025 , 52 (23) : 4371 -4376
社会支持和生活习惯在老年人健在子女个数与痴呆关联中的作用
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赵晓兰1, 2, 3, 王冬喜1, 2, 3, 程桂荣1, 2, 3, 张鹏4, 李锐5, 黄招兰6
作者信息
  • 1.武汉科技大学医学部,湖北 武汉 430065
  • 2.武汉科技大学脑科学先进技术研究院,湖北 武汉 430065
  • 3.湖北省阿尔茨海默病临床医学研究中心,武汉科技大学附属天佑医院,湖北 武汉 430064
  • 4.武汉市武昌医院科教科
  • 5.武汉市武昌医院肾病免疫科
  • 6.武汉科技大学附属老年病医院,湖北 武汉 430065
通讯作者:
黄招兰,E-mail:
作者简介:

赵晓兰 (1990—) ,女,硕士在读,主管护师,研究方向:老年认知功能障碍

The roles of social support and lifestyle habits in the association between number of living children and dementia among older adults
Xiao-lan ZHAO1, 2, 3, Dong-xi WANG1, 2, 3, Gui-rong CHENG1, 2, 3, Peng ZHANG4, Rui LI5, Zhao-lan HUANG6
Affiliations
  • Medical College, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
出版时间: 2025-12-10 doi: 10.20043/j.cnki.MPM.202505111
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目的

探讨老年人健在子女个数与痴呆的关联性,以及社会支持和生活方式对该关联的影响。

方法

选取湖北老年记忆队列6 232名≥65岁老年人,按健在子女个数分组(0个、1~2个和≥3个);采用多因素logistic回归分析其与痴呆的关联,进行城乡、性别、受教育程度及个人月收入分层分析,并探讨社会支持和生活方式对该关联的影响。

结果

相较于有1~2个健在子女的老年人,无健在子女(OR=1.705,95% CI: 1.205~2.412)和≥3个健在子女(OR=1.344,95% CI:1.030~1.753)的老年人痴呆患病风险均升高。分层分析显示:相较于有1~2个健在子女的老年人,无健在子女的农村(OR=2.392,95% CI: 1.544~3.707)、男性(OR=2.013,95% CI: 1.190~3.404)、女性(OR=1.854,95% CI: 1.094~3.144)、低受教育水平(OR=1.859,95% CI: 1.278~2.702)和低个人月收入(OR=1.802,95% CI: 1.211~2.682)老年人的痴呆患病风险更高;健在子女个数≥3个的城市(OR=2.677,95% CI: 1.557~4.603)、男性(OR=2.058,95% CI: 1.259~3.363)、高受教育水平(OR=2.550,95% CI: 1.298~5.009)和高个人月收入(OR=2.424,95% CI: 1.096~5.361)老年人的痴呆患病风险均更高。与社会支持差、生活习惯差的老年人相比,未分组中社会支持好(OR=0.569,95% CI: 0.453~0.716)、生活习惯好(OR=0.485,95% CI: 0.381~0.618)老年人的痴呆患病风险较低;无健在子女的老年人中,生活习惯好(OR=0.515,95% CI: 0.276~0.960)老年人的痴呆患病风险更低;健在子女≥3个的老年人中,社会支持好(OR=0.410,95% CI: 0.306~0.549)、生活习惯好(OR=0.419,95% CI: 0.307~0.573)老年人的痴呆患病风险均更低。

结论

健在子女个数为0或≥3个比1~2个的老年人痴呆患病风险均升高;与1~2个健在子女的老年人相比,无健在子女的农村、男性、女性、低受教育水平和低个人月收入老年人和≥3个健在子女的城市、男性、高受教育水平和高个人月收入老年人的痴呆患病风险均更高;良好的社会支持和健康的生活习惯与未分组及多子女老年人较低的痴呆患病风险有关,且健康生活习惯也与无健在子女老年人较低的痴呆患病风险有关,但在1~2个健在子女的人群中,未发现显著关联。

老年人  /  痴呆  /  健在子女个数  /  社会支持  /  生活习惯
Objective

To explore the association between the number of living children and dementia among older adults, as well as the influence of social support and lifestyle on this association.

Methods

This study included 6 232 participants aged ≥65 years from the Hubei Memory and Aging Cohort, categorized by number of living children (0, 1-2, ≥3). Multivariable logistic regression was used to analyze the associations with dementia, stratified by residence, sex, education level, and personal monthly income, while also examining the modifying effects of social support and lifestyle habits.

Results

Compared to older adults with 1-2 living children, those with no living children (OR=1.705, 95% CI: 1.205-2.412) and ≥3 living children (OR=1.344, 95% CI:1.030-1.753) had an increased risk of dementia. Stratified analysis revealed that compared with elderly people with 1-2 living children, those without living children in rural areas (OR=2.392, 95% CI: 1.544-3.707), males (OR=2.013, 95% CI: 1.190-3.404), females (OR=1.854, 95% CI: 1.094-3.144), those with low education levels (OR=1.859, 95% CI: 1.278-2.702), and those with low personal monthly income (OR=1.802, 95% CI: 1.211-2.682) had significantly higher risks of dementia. Among older adults with ≥3 living children, urban residents (OR=2.677, 95% CI: 1.557-4.603), males (OR=2.058, 95% CI: 1.259-3.363), those with higher education levels (OR=2.550, 95% CI: 1.298-5.009), and those with higher personal monthly income(OR=2.424, 95% CI: 1.096-5.361) all showed significantly elevated risks of dementia. Compared to older adults with poor social support and unhealthy lifestyles, the overall population with good social support (OR=0.569, 95% CI: 0.453-0.716) and healthy lifestyles (OR=0.485, 95% CI: 0.381-0.618) showed significantly lower dementia risk. Among childless older adults, those maintaining healthy lifestyles demonstrated even greater risk reduction (OR=0.515, 95% CI: 0.276-0.960). Among those with ≥3 living children, both good social support (OR=0.410, 95% CI: 0.306-0.549) and healthy lifestyles (OR=0.419, 95% CI: 0.307-0.573) were associated with the most substantial protective effects against dementia.

Conclusion

Older adults with no living children or ≥3 living children had significantly higher dementia risk compared to those with 1-2 living children. Compared with the elderly with 1-2 living children, the elderly in rural areas, males, females, with low education levels and low monthly personal income without living children, and urban elderly with ≥3 living children, males, and those with higher education levels and high monthly personal income had a higher risk of developing dementia. Good social support and healthy living habits were associated with a lower risk of dementia in the ungrouped population and elderly people with multiple children. Moreover,healthy living habits were also associated with a lower risk of dementia in the elderly without living children. No significant association was observed among those with 1-2 living children.

Elderly  /  Dementia  /  Number of living children  /  Social support  /  Lifestyle habits
赵晓兰, 王冬喜, 程桂荣, 张鹏, 李锐, 黄招兰. 社会支持和生活习惯在老年人健在子女个数与痴呆关联中的作用. 现代预防医学, 2025 , 52 (23) : 4371 -4376 . DOI: 10.20043/j.cnki.MPM.202505111
Xiao-lan ZHAO, Dong-xi WANG, Gui-rong CHENG, Peng ZHANG, Rui LI, Zhao-lan HUANG. The roles of social support and lifestyle habits in the association between number of living children and dementia among older adults[J]. Modern Preventive Medicine, 2025 , 52 (23) : 4371 -4376 . DOI: 10.20043/j.cnki.MPM.202505111
据第七次全国人口普查结果,2020年我国总和生育率为1.3,远低于人口世代更替水平。且呈现无子女家庭增多,多孩家庭减少[1]。尽管我国已实施生育激励政策,但受经济负担、生育观转变等多因素影响,生育率仍维持在较低水平。与此同时,人口老龄化进程持续加速,2023年末65岁及以上人口为2.17亿,占比15.4%[2]。少子化及老龄化的叠加效应正挑战医疗保障和家庭健康管理体系。
痴呆是以进行性认知功能损害为特征的神经退行性疾病,严重影响患者生活质量并带来沉重社会负担[3]。已有研究表明,无子女或子女数量过多可能对老年人认知功能产生不利影响[4],但大多基于西方国家,且结果存在异质性[5]。此外,研究还表明,良好的社会支持及健康生活方式与老年人认知功能及较低的痴呆患病风险有关[6-7]。
在我国逐渐突出的少子化和加速老龄化的背景下,社会支持和生活习惯能否在一定程度影响痴呆的患病风险仍缺乏大规模人群调查的实证研究。因此,本研究利用中国中部地区大规模人群队列(湖北老年记忆队列),探讨老年人健在子女个数与痴呆的关联及社会支持和生活习惯对这种关联性的影响,为老年人痴呆防控提供科学依据。
研究对象来自湖北老年记忆队列(Hubei Memory and Aging Cohort Study, HMACS)2018—2024年的基线调查人群,HMACS采用整群随机抽样方法,抽取了湖北省武汉市3个社区卫生服务中心和大悟县的 48 个村作为城市和农村抽样人群,基线期共纳入11 656人[8]。本研究排除65岁以下、重要信息缺失和健在子女信息缺失人群,最终纳入本研究6 232人。本研究已获武汉科技大学医学伦理委员会批准(No:201845),所有参与者均已签署书面知情同意书。
问卷调查组由医学院脑科学先进技术研究院专家、医学专业研究生及卫生服务中心相关专业医生和护士组成。数据收集采用结构化问卷面对面访谈、体格检查、一系列神经心理量表评估及实验室生化检查。收集参与者的社会人口学特征、个人生活史、既往疾病史、家族疾病史,测量身高、体重、血压、心率、腰围、握力等生理指标,体格检查内科、外科、五官科以及血液样本的实验室检测评估参与者的健康状况。
采用一系列标准化的神经心理学评估工具,全面评估研究对象的认知功能、精神行为以及日常生活能力。简易精神状态量表(mini-mental state examination,MMSE)[9]和蒙特利尔认知评估基础量表中文版(Montreal cognitive assessment-basic,MoCA-B)[10],以评估参与者整体认知水平。华山版听觉词语学习测验(auditory verbal learning test,AVLT)、波士顿命名测验(Boston naming test, BNT)、语言流畅性测试(verbal fluency test, VFT)、数字广度测验(digit span test, DST)以及连线试验(trail making test A, TMT-A)[11]分别评估参与者的记忆、语言、注意力及信息加工速度等分域认知功能。老年抑郁量表(geriatric depression scale, GDS-15)[12]评估参与者抑郁状态。日常生活能力量表评估受试者日常生活能力[13]。
采用面对面访谈收集参与者目前健在子女个数并分为三组:0、1~2和≥3个。
由二名神经科专家和二名神经心理学专家组成专家小组,根据2018中国痴呆与认知障碍诊治指南来完成。既往智力正常者出现获得性认知功能下降(记忆、执行、语言或视空间能力损害)或精神行为异常,影响工作能力或日常生活,且无法用谵妄或其他精神疾病来解释的患者,可拟诊为痴呆[14]。
社会支持采用社会支持评定量表(social support rate scale,SSRS)[15]评估,包含(固定收入、配偶、收入满意度、家人同住、健在兄弟姐妹、亲密朋友、邻里交流和紧急支持)8个条目。“否”赋0分,“是”赋1分,总分8分,0~4分为社会支持差,5~8分为社会支持好。生活习惯参考贾建平[16]等制定的标准,包括6个指标:吸烟、饮酒、不健康饮食、体重过瘦(BMI<18.5 kg/m2)或过胖(BMI>23.9 kg/m2)、不参加体育锻炼、不参加智力活动。“否”赋0分,“是”赋1分,总分6分,0~3分为生活习惯好,4~6分为生活习惯差。不健康饮食参考世界卫生组织营养指南,定义为存在以下任意一行为≥2次/周:(1)暴饮暴食;(2)其他饮食习惯(如:只吃早午餐,吃下午茶或夜宵,半夜醒来进食,不吃午饭、不吃晚饭);(3)不吃早饭;(4)动物脂肪摄入量高;(5)很少吃水果、鱼和蔬菜。
本研究对调查组研究人员进行标准化培训,全员必须通过笔试、模拟面试和现场测试三轮考核通过方可参与调查。采集的数据当天审核后采用EpiData 3.0平行双录入,并进行逻辑检查,确保数据准确性。研究小组的质量管理员每周进行数据质量核查,确保数据的完整性和一致性。
使用SPSS 27.0软件进行统计分析。采用Kolmogorov-Smirnov test对连续变量进行正态性检验。非正态分布的连续变量,采用中位数及四分位数间距[M(P25,P75)]描述;分类变量则采用频数和构成比表示。组间差异比较使用Kruskal-Wallis 秩和检验和χ2检验。健在子女个数与痴呆相关性的分析采用多因素logistic回归分析模型,并进行居住地、性别、受教育程度和个人月收入的分层分析,进一步按照社会支持和生活方式分组分析老年人健在子女个数与痴呆的关联。双侧检验,检验水准α=0.05。
本研究共纳入6 232名≥65岁参与者,年龄的[M(P25,P75)]为71(68,76)岁,女性参与者3 404(54.6%)人,农村参与者2 652(42.6%)人,受教育年限[M(P25,P75)]为8(1,12)年。痴呆的患病人数451(7.2%)人。无健在子女、1~2和≥3个健在子女的老年人分别有773(12.4%)、3 532(56.7%)和1 927(30.9%)人,健在子女个数的分布与年龄、居住地、性别、教育程度、个人月收入、社会支持、生活习惯、高血压、高血脂、冠心病、脑血管病、抑郁、痴呆差异均存在统计学意义(P<0.05)。见表1。
分别以研究对象是否患有痴呆为因变量(0=否,1=是)进行多因素logistic回归分析,全变量调整模型显示无健在子女(OR=1.705,95% CI: 1.205~2.412)和健在子女个数≥3个(OR=1.344,95% CI: 1.030~1.753)老年人患有痴呆的风险分别是健在子女个数1~2个老年人的1.705和1.344倍。见表2。
根据不同居住地、性别、受教育程度和个人月收入进行多因素logistic回归,结果显示与健在子女1~2个老年人相比,无健在子女的农村(OR=2.392,95% CI: 1.544~3.707)、男性(OR=2.013,95% CI: 1.190~3.404)、低受教育程度(OR=1.859,95% CI: 1.278~2.702)、低个人月收入(OR=1.802,95% CI: 1.211~2.682)的老年人痴呆患病风险更高。健在子女≥3个的老年人中,城市(OR=2.677,95% CI: 1.557~4.603)、男性(OR= 2.058,95% CI: 1.259~3.363)、高受教育水平(OR= 2.550,95% CI: 1.298~5.009)的老年人痴呆患病风险均更高。见表3。
采用多因素logistic回归模型,在控制混杂因素后,分别分析社会支持和生活方式对老年人健在子女数量与痴呆关联性的影响,结果显示与社会支持差、生活习惯差人群相比,未分组中社会支持好(OR=0.569,95% CI: 0.453~0.716)、生活习惯好(OR=0.485,95% CI: 0.381~0.618)的老年人痴呆患病风险较低;无健在子女中生活习惯好(OR=0.515,95% CI: 0.276~0.960)的老年人痴呆患病风险更低;健在子女≥3个老年人中,社会支持好(OR=0.410,95% CI: 0.306~0.549)、生活习惯好(OR=0.419,95% CI: 0.307~0.573)的老年人痴呆患病风险均更低;在无健在子女且社会支持好、有1~2个健在子女且社会支持好和生活习惯好的老年人中,显示潜在的保护性关联但未达统计学意义(均OR<1且P>0.05)。见表4。
本研究基于HMACS认知评估数据,探讨了老年人健在子女个数与痴呆的关联性。研究显示,无健在子女和健在子女≥3个的老年人痴呆的患病风险分别为健在子女1~2个的1.705和1.344倍,结果呈现“U”型曲线关系。这一发现与国际上关注生育子女数量的大部分研究结果一致[17-18],也为中国特定家庭结构背景与认知健康的关系提供了新的证据。
从生物学角度,无子女老年人的认知风险可能源于慢性应激反应,持续的下丘脑-垂体-肾上腺轴激活导致糖皮质激素过量,进而加速神经元凋亡[19]。同时,缺乏子女的监督和照料,使得这部分老年群体在健康行为依从性方面表现较差,加速认知衰退[20]。相较之下,多子女家庭虽具潜在照料优势,但其痴呆发生率仍较高,可能与照料资源分散导致的个体化支持不足有关,反映出子女数量与质量的复杂平衡关系。需特别关注的是,多子女家庭的经济压力可能通过诱发慢性应激,对家庭主要成员的认知功能产生潜在影响[21]。
此外,无健在子女的农村、低教育、低收入老年人群表现出更高的痴呆患病风险。该发现与范仁嘉[22]等关于低经济地位人群痴呆风险升高的研究结论相吻合,尤其在我国农村地区,社会保障薄弱和社会资源匮乏进一步加剧了无子女老年人的风险[23]。而在城市、高教育和高收入的群体中,≥3个健在子女的老年人患有痴呆的概率明显增加,这一现象可能源于子女数量增加导致代际疏离和养育压力加剧。值得注意的是,多子女对于男性的影响高于女性,这与Zhang等[24]的研究结论不同,可能反映我国男性作为主要经济支柱在多子女家庭中承受更大压力。
此外,社会支持和生活习惯在健在子女个数与痴呆关联中存在潜在调节作用,与既往研究一致[25-26]。但值得一提的是,健康行为对无子女老人的保护效应尤为显著,而多子女老人需同时优化社会支持和保持健康生活方式,共同维护认知储备。研究建议实施差异化干预,推动从“均质化干预”到“精准预防”的转变。
本研究具有一定的创新性:(1)国内关于健在子女个数与痴呆关联的研究较为有限,主要聚焦于国外。(2)多数研究仅关注女性生育次数,且主要从生物学机制角度进行探讨。本研究采用健在子女个数这一反映实际社会支持的指标,更符合我国人口老龄化的现状。此外,纳入男女两性样本,从社会学视角丰富了研究维度。(3)研究还发现社会支持和生活习惯可能调节这一关联,并为针对不同子女个数的痴呆高风险老年人群制定差异化预防策略提供了科学依据。
但也存在一些局限性:(1)本研究是一项横断面研究,限制因果推断;(2)社会支持和生活习惯数据可能存在自我报告偏倚;(3)痴呆诊断基于神经心理量表和临床评估,未能对所有参与者进行神经影像学(如MRI/PET)。我们已启动影像学验证子研究,后续将通过纵向随访数据进一步验证诊断可靠性。
  • 武汉市医学科学研究项目(WX23B01)
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2025年第52卷第23期
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doi: 10.20043/j.cnki.MPM.202505111
  • 接收时间:2025-05-10
  • 首发时间:2026-11-02
  • 出版时间:2025-12-10
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  • 收稿日期:2025-05-10
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武汉市医学科学研究项目(WX23B01)
作者信息
    1.武汉科技大学医学部,湖北 武汉 430065
    2.武汉科技大学脑科学先进技术研究院,湖北 武汉 430065
    3.湖北省阿尔茨海默病临床医学研究中心,武汉科技大学附属天佑医院,湖北 武汉 430064
    4.武汉市武昌医院科教科
    5.武汉市武昌医院肾病免疫科
    6.武汉科技大学附属老年病医院,湖北 武汉 430065

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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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