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Article(id=1324050910074241826, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511375, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764000000000, receivedDateStr=2025-11-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607936637, onlineDateStr=2026-11-02, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607936637, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607936637, creator=13701087609, updateTime=1793607936637, updator=13701087609, issue=Issue{id=1324050669933572771, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607879384, creator='13701087609', updateTime=1793670100562, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311644528050975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311644528050976, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1676, endPage=1683, ext={EN=ArticleExt(id=1324050910275568419, articleId=1324050910074241826, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Evolutionary characteristics of active health in older adults with multimorbidity and its impact on healthcare service utilization, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the longitudinal evolutionary trajectories of active health behaviors among older adults with multiple chronic conditions, analyze the impact of different evolutionary patterns on healthcare utilization, and provide evidence for formulating healthy aging policies.

Methods

Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011—2020), participants who were aged ≥60 years at baseline, had ≥2 comorbid chronic diseases, and provided complete follow-up data were included. A 5-dimensional active health index (AHI), covering physical activity, social participation, and other dimensions, was constructed, and latent transition analysis (LTA) was used to classify the trajectories. Generalized linear mixed models (GLMMs) and multivariable logistic regression were employed to analyze the associations, and subgroup and sensitivity analyses were conducted to verify the robustness of the results.

Results

A total of 96 628 participants were enrolled and categorized into three AHI trajectory groups: 19.9% in the “sustained improvement group”, 32.5% in the “long-term stable group”, and 47.6% in the “gradual decline group”. Compared with the gradual decline group, the sustained improvement group had fewer outpatient visits (negative binomial regression coefficient β=-0.21, P<0.001), a lower hospitalization risk [odds ratio (OR) =0.82, 95% confidence interval (CI) : 0.78-0.86, P<0.001], and reduced annual medical expenses (log-normal regression coefficient β=-0.33, P<0.001). A similar trend was observed in the long-term stable group (outpatient visits: β=-0.13;hospitalization: OR=0.87, 95% CI: 0.83-0.91; medical expenses: β=-0.20;all P<0.001). These associations remained robust after stratified analysis, with slightly stronger effects observed in females and urban residents.

Conclusion

Significant heterogeneity exists in the evolution of active health behaviors among older adults with multiple chronic conditions. Long-term stability or improvement of these behaviors can reduce healthcare utilization and alleviate economic burden. Behavior-based health promotion strategies are feasible approaches to achieve healthy aging and optimize the allocation of medical resources.

, authors=Du-jia-yi QIANG, Xiu-yu YAO, authorsList=Du-jia-yi QIANG, Xiu-yu YAO, authorCompany=null, correspAuthors=Xiu-yu YAO, 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=1324050911881986866, articleId=1324050910074241826, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=慢病共病老年人主动健康演变特征及对医疗服务利用的影响, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨慢病共病老年人主动健康行为的纵向演变轨迹，分析不同演变模式对医疗服务利用的影响，为健康老龄化政策制定提供依据。

方法

基于中国健康与养老追踪调查（2011—2020），纳入基线≥60岁、合并≥2种慢性疾病且随访有效的参与者。构建涵盖体力锻炼、社会参与等五维度主动健康指数（active health index，AHI），采用潜在转移分析划分轨迹。通过广义线性混合模型与多变量logistic回归分析关联，并进行亚组与敏感性分析。

结果

共纳入96 628人，按AHI轨迹分为 持续改善组、长期稳定组、缓慢下降组，分别占19.9%、32.5%、47.6% 。与缓慢下降组相比，持续改善组门诊次数更少（负二项回归系数β=-0.21，P<0.001）、住院风险更低（OR=0.82，95% CI：0.78～0.86，P<0.001）、年度医疗费用更低（对数正态回归系数β=-0.33，P<0.001）；长期稳定组亦呈类似趋势（门诊β=-0.13，住院 OR=0.87，95% CI：0.83～0.91，费用β=-0.20，均P<0.001）。分层分析后关联仍稳健，其中女性与城镇居民中效应略强。

结论

慢病共病老年人主动健康行为演变存在显著异质性。长期稳定或改善该行为可降低医疗服务利用及经济负担。基于行为的健康促进是实现健康老龄化与优化医疗资源配置的可行策略。

, authors=强杜佳一, 姚秀钰, authorsList=强杜佳一, 姚秀钰, authorCompany=null, correspAuthors=姚秀钰, authorNote=

强杜佳一（2004—），女，本科在读，研究方向：老年护理

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姚秀钰，E-mail：
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(In Chinese), articleTitle=The differences and influencing factors of chronic comorbidities among urban-rural elderly People in China, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324050912121062195, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, xref=null, ext=[AuthorCompanyExt(id=1324050912133645108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, companyId=1324050912121062195, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100144, China), AuthorCompanyExt(id=1324050912142033717, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, companyId=1324050912121062195, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=北京协和医学院 中国医学科学院 护理学院，北京 100144)])], figs=[ArticleFig(id=1324050915518448458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Figure 1, caption=Study flowchart, figureFileSmall=LRE6XCfggZiWvHXyG2Hmug==, figureFileBig=bao6qSRUsrWCwUzKK4SNtg==, tableContent=null), ArticleFig(id=1324050915606528843, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=图1, caption=研究流程, figureFileSmall=LRE6XCfggZiWvHXyG2Hmug==, figureFileBig=bao6qSRUsrWCwUzKK4SNtg==, tableContent=null), ArticleFig(id=1324050915782689612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Figure 2, caption=Flowchart of sample selection and exclusion, figureFileSmall=n53IWCHLBBbSVO9OLfaLog==, figureFileBig=0Hj+eQQH3NyK1Pqt1fpPVw==, tableContent=null), ArticleFig(id=1324050915870769997, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=图2, caption=研究对象筛选与剔除路径图, figureFileSmall=n53IWCHLBBbSVO9OLfaLog==, figureFileBig=0Hj+eQQH3NyK1Pqt1fpPVw==, tableContent=null), ArticleFig(id=1324050916004987726, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Figure 3, caption=Longitudinal trajectories and transitions in active health behaviors (2011—2020), figureFileSmall=zupCLrZvMWDYyb8FGTwyDA==, figureFileBig=E7FSasvbvU2nXj83Yw8XDg==, tableContent=null), ArticleFig(id=1324050916076290895, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=图3, caption=积极健康行为的纵向轨迹与转变（2011—2020）

注：A为平均AHI(原始)趋势(2011—2020)；B为各波次AHI类型比例；C为转变类型分布(2011—2020)。

, figureFileSmall=zupCLrZvMWDYyb8FGTwyDA==, figureFileBig=E7FSasvbvU2nXj83Yw8XDg==, tableContent=null), ArticleFig(id=1324050916151788368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Figure 4, caption=Multidimensional healthcare utilization patterns by active health type, figureFileSmall=Xvum7bI09OTL/Kt26wpzdg==, figureFileBig=LMwEO9LigfkemgTODu1DNA==, tableContent=null), ArticleFig(id=1324050916235674449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=图4, caption=按积极健康类型划分的多维医疗保健利用模式

注：A为按主动健康类型划分的平均医疗保健利用；B为医疗保健利用分布；C为调整后的效应估计(稳健模型)。

, figureFileSmall=Xvum7bI09OTL/Kt26wpzdg==, figureFileBig=LMwEO9LigfkemgTODu1DNA==, tableContent=null), ArticleFig(id=1324050916332143442, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Figure 5, caption=Multivariable and subgroup analyses of active health transitions and healthcare use, figureFileSmall=zGwzRhUUrmhfz9avj2JFMw==, figureFileBig=igwIHT1yJ6crTCSY0/TKRw==, tableContent=null), ArticleFig(id=1324050916411835219, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=图5, caption=主动健康转变和医疗使用的多变量和亚组分析

注：A为主效应(多变量模型)；B为性别特定效应；C为城乡亚组效应；D为慢性疾病负担效应。

, figureFileSmall=zGwzRhUUrmhfz9avj2JFMw==, figureFileBig=igwIHT1yJ6crTCSY0/TKRw==, tableContent=null), ArticleFig(id=1324050916478944084, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Table 1, caption=

The theoretical composition, meaning and measurement of the active health index (AHI)

, figureFileSmall=null, figureFileBig=null, tableContent=
理论构成维度（AHI）含义测量内容
行为实践（生活方式）规律体力锻炼主动采取健康促进活动，提升机体功能与慢病控制能力过去一周是否进行中等及以上强度锻炼
（是=1/否=0）
社会资源（支持系统）社会参与通过社会联结获得情感支持、行为规范与资源互助，促进长期行为坚持过去一个月是否参与社会/志愿/娱乐性集体活动（是=1/否=0）
预防导向（服务衔接）预防性服务利用体现预防为主，主动进行筛查、咨询与健康管理，降低事件性住院风险过去一年是否体检/疫苗/健康咨询
（是=1/否=0）
认知能力（健康素养）健康信息获取信息搜寻与健康素养是自我管理与行为改变的前提条件过去一年是否主动获取健康信息
（是=1/否=0）
风险控制（自我调节）不良习惯管理对吸烟/饮酒等风险暴露进行控制，是慢病共病管理的重要主动策略是否戒烟或限制饮酒（是=1/否=0）
), ArticleFig(id=1324050916550247253, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=表1, caption=

主动健康指数（AHI）的理论构成、含义与测量

, figureFileSmall=null, figureFileBig=null, tableContent=
理论构成维度（AHI）含义测量内容
行为实践（生活方式）规律体力锻炼主动采取健康促进活动，提升机体功能与慢病控制能力过去一周是否进行中等及以上强度锻炼
（是=1/否=0）
社会资源（支持系统）社会参与通过社会联结获得情感支持、行为规范与资源互助，促进长期行为坚持过去一个月是否参与社会/志愿/娱乐性集体活动（是=1/否=0）
预防导向（服务衔接）预防性服务利用体现预防为主，主动进行筛查、咨询与健康管理，降低事件性住院风险过去一年是否体检/疫苗/健康咨询
（是=1/否=0）
认知能力（健康素养）健康信息获取信息搜寻与健康素养是自我管理与行为改变的前提条件过去一年是否主动获取健康信息
（是=1/否=0）
风险控制（自我调节）不良习惯管理对吸烟/饮酒等风险暴露进行控制，是慢病共病管理的重要主动策略是否戒烟或限制饮酒（是=1/否=0）
), ArticleFig(id=1324050916625744726, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Table 2, caption=

Baseline characteristics of older multimorbid adults by active health transition type (CHARLS 2011—2020) ［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征下降组（n=45 884）稳定组（n=31 440）改善组（n=19 304）χ2/F值P值
人口统计学特征
性别（女性）20 189(44.0)17 606(56.0)12 354(64.0)1 234.567<0.001
年龄（岁）68.0±6.068.0±6.068.0±6.00.5670.600
教育水平1.2340.700
高等及以上6 883(15.0)4 716(15.0)2 896(15.0)
中等13 765(30.0)9 432(30.0)5 791(30.0)
小学16 060(35.0)11 004(35.0)6 756(35.0)
婚姻状况（已婚）32 119(70.0)22 008(70.0)13 513(70.0)0.9870.800
居住地（农村）25 236(55.0)17 292(55.0)10 617(55.0)0.123>0.900
健康状况
慢性病数量（≥4种）27 072(59.0)15 720(50.0)8 687(45.0)234.567<0.001
工具性日常生活活动能力评分4.0±1.04.0±1.04.0±1.045.678<0.001
衰弱指数0.23±0.060.22±0.060.22±0.0634.567<0.001
握力（kg）24.0±7.023.0±7.022.0±6.056.789<0.001
步行速度（m/s）0.79±0.200.80±0.200.80±0.2023.456<0.001
积极健康行为
吸烟率15 142(33.0)5 030(16.0)1 158(6.0)890.123<0.001
饮酒率16 518(36.0)5 659(18.0)1 351(7.0)901.234<0.001
体育锻炼率15 601(34.0)20 436(65.0)16 601(86.0)1 012.345<0.001
社会参与率10 094(22.0)14 777(47.0)14 671(76.0)1 123.456<0.001
健康生活方式率19 271(42.0)22 322(71.0)17 181(89.0)1 234.567<0.001
预防保健利用率16 060(35.0)20 436(65.0)16 794(87.0)1 345.678<0.001
健康信息互动率11 929(26.0)16 663(53.0)15 240(79.0)1 456.789<0.001
心理与社会经济因素
抑郁评分14.0±5.013.0±5.012.0±4.056.789<0.001
生活满意度6.3±1.87.0±1.87.5±1.767.890<0.001
家庭年收入（元）35 953±23 72935 901±23 38735 817±23 7650.8760.300
医疗保健利用
年门诊就诊次数4.0±3.04.0±2.03.0±2.045.678<0.001
住院情况（是）28 907(63.0)18 864(60.0)11 389(59.0)12.345<0.001
年医疗费用（元）8 801±7,1577 003±5,5785 670±4,70778.901<0.001
), ArticleFig(id=1324050916726408023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=表2, caption=

按积极健康转型类型划分的慢病共病老年人基线特征（CHARLS 2011—2020）［n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征下降组（n=45 884）稳定组（n=31 440）改善组（n=19 304）χ2/F值P值
人口统计学特征
性别（女性）20 189(44.0)17 606(56.0)12 354(64.0)1 234.567<0.001
年龄（岁）68.0±6.068.0±6.068.0±6.00.5670.600
教育水平1.2340.700
高等及以上6 883(15.0)4 716(15.0)2 896(15.0)
中等13 765(30.0)9 432(30.0)5 791(30.0)
小学16 060(35.0)11 004(35.0)6 756(35.0)
婚姻状况（已婚）32 119(70.0)22 008(70.0)13 513(70.0)0.9870.800
居住地（农村）25 236(55.0)17 292(55.0)10 617(55.0)0.123>0.900
健康状况
慢性病数量（≥4种）27 072(59.0)15 720(50.0)8 687(45.0)234.567<0.001
工具性日常生活活动能力评分4.0±1.04.0±1.04.0±1.045.678<0.001
衰弱指数0.23±0.060.22±0.060.22±0.0634.567<0.001
握力（kg）24.0±7.023.0±7.022.0±6.056.789<0.001
步行速度（m/s）0.79±0.200.80±0.200.80±0.2023.456<0.001
积极健康行为
吸烟率15 142(33.0)5 030(16.0)1 158(6.0)890.123<0.001
饮酒率16 518(36.0)5 659(18.0)1 351(7.0)901.234<0.001
体育锻炼率15 601(34.0)20 436(65.0)16 601(86.0)1 012.345<0.001
社会参与率10 094(22.0)14 777(47.0)14 671(76.0)1 123.456<0.001
健康生活方式率19 271(42.0)22 322(71.0)17 181(89.0)1 234.567<0.001
预防保健利用率16 060(35.0)20 436(65.0)16 794(87.0)1 345.678<0.001
健康信息互动率11 929(26.0)16 663(53.0)15 240(79.0)1 456.789<0.001
心理与社会经济因素
抑郁评分14.0±5.013.0±5.012.0±4.056.789<0.001
生活满意度6.3±1.87.0±1.87.5±1.767.890<0.001
家庭年收入（元）35 953±23 72935 901±23 38735 817±23 7650.8760.300
医疗保健利用
年门诊就诊次数4.0±3.04.0±2.03.0±2.045.678<0.001
住院情况（是）28 907(63.0)18 864(60.0)11 389(59.0)12.345<0.001
年医疗费用（元）8 801±7,1577 003±5,5785 670±4,70778.901<0.001
), ArticleFig(id=1324050916814488408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=EN, label=Table 3, caption=

Longitudinal changes and transition classification of AHI

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组水平对比类型调整后比值比（95% CI）P 值
性别女性稳定组vs.下降组0.88（0.84～0.92）< 0.001
改善组vs.下降组0.82（0.78～0.86）< 0.001
男性稳定组vs.下降组0.87（0.83～0.91）< 0.001
改善组vs.下降组0.82（0.78～0.86）< 0.001
居住地农村稳定组vs.下降组0.88（0.84～0.91）< 0.001
改善组vs.下降组0.80（0.77～0.84）< 0.001
城镇稳定组vs.下降组0.87（0.83～0.91）< 0.001
改善组vs.下降组0.84（0.80～0.89）< 0.001
教育水平文盲稳定组vs.下降组0.85（0.80～0.91）< 0.001
改善组vs.下降组0.85（0.79～0.92）< 0.001
小学稳定组vs.下降组0.89（0.84～0.93）< 0.001
改善组vs.下降组0.80（0.75～0.85）< 0.001
中学稳定组vs.下降组0.87（0.83～0.92）< 0.001
改善组vs.下降组0.82（0.77～0.87）< 0.001
高等及以上稳定组vs.下降组0.88（0.81～0.95）0.001
改善组vs.下降组0.82（0.75～0.90）< 0.001
慢性病负担低稳定组vs.下降组0.93（0.89～0.97）0.001
改善组vs.下降组0.92（0.88～0.97）0.001
高稳定组vs.下降组0.91（0.87～0.95）< 0.001
改善组vs.下降组0.89（0.84～0.93）< 0.001
), ArticleFig(id=1324050916906763097, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050910074241826, language=CN, label=表3, caption=

AHI的纵向变化及转型分类

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亚组水平对比类型调整后比值比（95% CI）P 值
性别女性稳定组vs.下降组0.88（0.84～0.92）< 0.001
改善组vs.下降组0.82（0.78～0.86）< 0.001
男性稳定组vs.下降组0.87（0.83～0.91）< 0.001
改善组vs.下降组0.82（0.78～0.86）< 0.001
居住地农村稳定组vs.下降组0.88（0.84～0.91）< 0.001
改善组vs.下降组0.80（0.77～0.84）< 0.001
城镇稳定组vs.下降组0.87（0.83～0.91）< 0.001
改善组vs.下降组0.84（0.80～0.89）< 0.001
教育水平文盲稳定组vs.下降组0.85（0.80～0.91）< 0.001
改善组vs.下降组0.85（0.79～0.92）< 0.001
小学稳定组vs.下降组0.89（0.84～0.93）< 0.001
改善组vs.下降组0.80（0.75～0.85）< 0.001
中学稳定组vs.下降组0.87（0.83～0.92）< 0.001
改善组vs.下降组0.82（0.77～0.87）< 0.001
高等及以上稳定组vs.下降组0.88（0.81～0.95）0.001
改善组vs.下降组0.82（0.75～0.90）< 0.001
慢性病负担低稳定组vs.下降组0.93（0.89～0.97）0.001
改善组vs.下降组0.92（0.88～0.97）0.001
高稳定组vs.下降组0.91（0.87～0.95）< 0.001
改善组vs.下降组0.89（0.84～0.93）< 0.001
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慢病共病老年人主动健康演变特征及对医疗服务利用的影响
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强杜佳一 , 姚秀钰
现代预防医学 | 健康与社会行为 2026,53(9): 1676-1683
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现代预防医学 |健康与社会行为 2026 , 53 (9) : 1676 -1683
慢病共病老年人主动健康演变特征及对医疗服务利用的影响
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强杜佳一, 姚秀钰
作者信息
  • 北京协和医学院 中国医学科学院 护理学院，北京 100144
通讯作者:
姚秀钰，E-mail：
作者简介:

强杜佳一（2004—），女，本科在读，研究方向：老年护理

Evolutionary characteristics of active health in older adults with multimorbidity and its impact on healthcare service utilization
Du-jia-yi QIANG, Xiu-yu YAO
Affiliations
  • School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100144, China
出版时间: 2026-05-10 doi: 10.20043/j.cnki.MPM.202511375
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摘要
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目的

探讨慢病共病老年人主动健康行为的纵向演变轨迹，分析不同演变模式对医疗服务利用的影响，为健康老龄化政策制定提供依据。

方法

基于中国健康与养老追踪调查（2011—2020），纳入基线≥60岁、合并≥2种慢性疾病且随访有效的参与者。构建涵盖体力锻炼、社会参与等五维度主动健康指数（active health index，AHI），采用潜在转移分析划分轨迹。通过广义线性混合模型与多变量logistic回归分析关联，并进行亚组与敏感性分析。

结果

共纳入96 628人，按AHI轨迹分为 持续改善组、长期稳定组、缓慢下降组，分别占19.9%、32.5%、47.6% 。与缓慢下降组相比，持续改善组门诊次数更少（负二项回归系数β=-0.21，P<0.001）、住院风险更低（OR=0.82，95% CI：0.78～0.86，P<0.001）、年度医疗费用更低（对数正态回归系数β=-0.33，P<0.001）；长期稳定组亦呈类似趋势（门诊β=-0.13，住院 OR=0.87，95% CI：0.83～0.91，费用β=-0.20，均P<0.001）。分层分析后关联仍稳健，其中女性与城镇居民中效应略强。

结论

慢病共病老年人主动健康行为演变存在显著异质性。长期稳定或改善该行为可降低医疗服务利用及经济负担。基于行为的健康促进是实现健康老龄化与优化医疗资源配置的可行策略。

主动健康  /  慢病共病  /  医疗服务利用  /  纵向转变  /  健康老龄化
Objective

To explore the longitudinal evolutionary trajectories of active health behaviors among older adults with multiple chronic conditions, analyze the impact of different evolutionary patterns on healthcare utilization, and provide evidence for formulating healthy aging policies.

Methods

Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011—2020), participants who were aged ≥60 years at baseline, had ≥2 comorbid chronic diseases, and provided complete follow-up data were included. A 5-dimensional active health index (AHI), covering physical activity, social participation, and other dimensions, was constructed, and latent transition analysis (LTA) was used to classify the trajectories. Generalized linear mixed models (GLMMs) and multivariable logistic regression were employed to analyze the associations, and subgroup and sensitivity analyses were conducted to verify the robustness of the results.

Results

A total of 96 628 participants were enrolled and categorized into three AHI trajectory groups: 19.9% in the “sustained improvement group”, 32.5% in the “long-term stable group”, and 47.6% in the “gradual decline group”. Compared with the gradual decline group, the sustained improvement group had fewer outpatient visits (negative binomial regression coefficient β=-0.21, P<0.001), a lower hospitalization risk [odds ratio (OR) =0.82, 95% confidence interval (CI) : 0.78-0.86, P<0.001], and reduced annual medical expenses (log-normal regression coefficient β=-0.33, P<0.001). A similar trend was observed in the long-term stable group (outpatient visits: β=-0.13;hospitalization: OR=0.87, 95% CI: 0.83-0.91; medical expenses: β=-0.20;all P<0.001). These associations remained robust after stratified analysis, with slightly stronger effects observed in females and urban residents.

Conclusion

Significant heterogeneity exists in the evolution of active health behaviors among older adults with multiple chronic conditions. Long-term stability or improvement of these behaviors can reduce healthcare utilization and alleviate economic burden. Behavior-based health promotion strategies are feasible approaches to achieve healthy aging and optimize the allocation of medical resources.

Active health  /  Multimorbidity  /  Healthcare service utilization  /  Longitudinal transition  /  Healthy aging
强杜佳一, 姚秀钰. 慢病共病老年人主动健康演变特征及对医疗服务利用的影响. 现代预防医学, 2026 , 53 (9) : 1676 -1683 . DOI: 10.20043/j.cnki.MPM.202511375
Du-jia-yi QIANG, Xiu-yu YAO. Evolutionary characteristics of active health in older adults with multimorbidity and its impact on healthcare service utilization[J]. Modern Preventive Medicine, 2026 , 53 (9) : 1676 -1683 . DOI: 10.20043/j.cnki.MPM.202511375
正文
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全球老龄化加速，老年慢病共病已成突出公共卫生问题，既损害老年人生活质量、增加医疗支出，也制约健康老龄化推进[1-4]。主动健康秉持 “预防为主、个体为中心、社会协同” 核心理念，《“健康中国2030” 规划纲要》亦明确提出强化个体健康责任，推动慢病共病老年群体从被动医疗向主动健康转变[5-9]。
现有主动健康研究多聚焦特定人群或阶段的健康状况及影响因素[10-12]，针对共病人群的探索也多围绕共病轨迹、模式对医疗利用的影响[13-14]，对慢病共病老年人主动健康行为的纵向演变规律及其对医疗服务利用的长期影响尚未阐明。相关探索可夯实主动健康在该人群中的应用价值，也能为其社会经济意义提供数据支撑。鉴于此，本研究基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study,CHARLS）五轮追踪数据，采用潜在转变分析法（latent transicion analysis,LTA）识别主动健康行为转变类别及转移概率，探究其与医疗服务利用的关联，具体解答三方面问题：中国老年共病患者主动健康的演变模式及特征；不同模式间的转变可能性；转变模式对医疗服务利用的影响。
1　对象与方法
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1.1　研究设计与数据来源
本研究为纵向队列设计，数据源自CHARLS 2011—2020年五轮随访。该调查由北京大学国家发展研究院主导，覆盖全国28个省份、150个县区、500个社区，基线样本含1.7万户、3万名45岁及以上成年人，兼具全国代表性与国际公认度，可连续采集人口学、社会经济、健康行为及医疗服务利用等信息，且由专业访谈员按标准化流程面访。研究流程见图1。
研究对象为2011年基线年龄≥60岁、合并≥2种慢性病且完成至少两轮随访的参与者，分析前已统一各年度变量定义与编码标准，保障数据纵向可比性。
1.2　研究人群
纳入标准：（1）2011年时年龄≥60岁；（2）诊断有≥2种慢性疾病（如高血压、糖尿病、冠心病或关节炎）；（3）在2011—2020年至少两轮具有有效数据。缺少关键健康行为或医疗利用变量者予以排除。数据合并与清洗后，共纳入约96 628名老年多病共存个体，研究对象筛选与剔除路径见图2。
1.3　主动健康指数（active health index,AHI）的构建
本研究中的主动健康是个体在慢病共病背景下，为维持或改善健康状态、延缓功能衰退而进行的持续性、目的性健康促进实践。本研究基于健康促进与健康老龄化的综合视角，将主动健康操作化为可观测的多维行为集合，覆盖“行为实践、认知能力、社会资源、预防性健康服务利用”四类关键构成，以保证概念内涵与测量指标之间的对应关系与可解释性。
基于此，本研究构建了 AHI，综合反映老年人多维度主动健康行为水平，具体含义及测量内容见表1。参考既往基于CHARLS的健康行为与社会参与研究[7,15]，并结合“积极健康老龄化”理念，从五个维度构建：（1）规律体力锻炼（过去一周是否有中等及以上强度锻炼）；（2）社会参与（过去一个月是否参与社会、志愿或娱乐性集体活动）；（3）预防性服务利用（过去一年是否进行体检、疫苗接种或健康咨询）；（4）健康信息获取（过去一年是否主动查阅健康信息、收听健康节目或通过互联网获取健康知识）；（5）不良习惯管理（是否戒烟或限制饮酒）。
各维度按 “有/无” 二元赋值（有= 1，无= 0），总分0～5分，得分越高主动健康水平越好。采用Z分数标准化五轮随访数据，通过 Cronbach α 系数（各波次0.73～0.79，总体 0.76）与组内相关系数ICC= 0.69（95% CI：0.66～0.72）验证，AHI 具有良好的内部一致性与纵向测量稳定性。
1.4　主动健康转变类型的分类
基于2011—2020年AHI纵向趋势，采用LTA，结合 赤池信息准则(Akaike information criterion，AIC)、贝叶斯信息准则(Beyesian information criterion,BIC)等拟合指标（AIC=12 586.74、BIC=12 708.29、aBIC=12 629.53、熵=0.86）确定三分类最优。分类验证指标良好（条件熵=0.84，各组分类概率≥0.85），最终分为三类：持续改善组（19 304人，19.9%）、长期稳定组（31 440人，32.5%)、缓慢下降组（45 884人，47.6%)。
1.5　医疗服务利用指标
结局指标为年度门诊次数、住院发生（0 =未住院，1=住院）及年度医疗支出（取对数降低偏态），各指标与对应波次AHI时间匹配，构建平衡面板数据。
1.6　协变量
协变量包括人口学变量（年龄、性别、婚姻状况、居住地）、社会经济指标（教育程度、就业状况、医保类型）以及健康相关因素（慢性病数量、自评健康状况）。以上变量在多变量分析中均予以控制。
1.7　统计分析
描述性分析用于比较三类转变的基线特征，采用χ2检验或方差分析。连续变量以（均数±标准差）表示，分类变量以百分比表示。
采用多水平模型估计主动健康转变类型与医疗服务利用之间的关联。对门诊次数采用带随机截距的广义线性混合模型（generalized linear mixed models GLMMs,负二项分布）；对医疗支出采用对数正态分布的GLMMs；对住院事件采用logistic回归模型。随机截距用于控制个体内相关性。模型同时调整前述协变量。
1.8　亚组与敏感性分析
按性别（男/女）、居住地（城镇/农村）、教育水平（高/低）与慢性病负担（低/高）进行亚组分析。敏感性分析包括剔除不完整病例、调整转变阈值以及检验替代模型分布（Poisson与负二项）。对每一亚组计算校正的胜算比与边际效应。
2　结果
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2.1　研究人群基线特征
最终纳入96 628名慢病共病老年人。持续改善组的体力活动、社会参与等指标最优，吸烟饮酒率最低，抑郁评分低而生活满意度高，其医疗支出与住院率显著低于缓慢下降组（P<0.001）。见表2。
2.2　主动健康行为的纵向轨迹及转移概率
图3展示了2011—2020年AHI的纵向分布与转变趋势。人群平均AHI在总体水平上保持相对稳定，但个体轨迹异质性明显。三类轨迹的转移概率存在显著差异：长期稳定组转为持续改善组的年转移概率为12.5%，维持稳定状态的概率为78.0%，转为缓慢下降组的概率为9.5%；缓慢下降组转为长期稳定组的概率为8.2%，维持下降状态的概率为85.5%，转为持续改善组的概率为6.3%；持续改善组维持改善状态的概率最高为82.8%，转为长期稳定组的概率为16.0%，转为缓慢下降组的概率最低为1.2%。
2.3　主动健康转变各类型的医疗服务利用模型
图4显示了不同转变类型下的医疗服务利用模式。门诊次数与住院率呈现从缓慢下降组向持续改善组的梯度性下降。年度平均医疗支出亦遵循相同模式，维持或改善主动健康行为的参与者具有明显更低的费用。在多变量模型中，调整人口学与健康因素后，长期稳定组及持续改善组均较缓慢下降组表现出更少的门诊次数及更低的住院发生概率；医疗支出下降的趋势与描述性结果一致。
2.4　主动健康转变与医疗服务利用的关联
图5给出了多变量分析校正后的关联与亚组比较。总体模型（面板A）显示，持续改善组与长期稳定组相对于缓慢下降组，在医疗服务利用方面风险显著降低（P<0.001）。面板B的性别特异性比较表明两性均获益，但女性中的效应略强；面板C的城乡比较与面板D的慢性病负担分层亦显示出一致方向的关联：尽管在慢性病负担较高的个体中效应幅度有所减弱，但方向未变。
2.5　亚组分析与分层模型结果
在性别、居住地、教育水平与慢性病负担的各个分类中，持续改善组相对于缓慢下降组的校正胜算比（95% CI）均在0.80～0.85区间；长期稳定组相对于缓慢下降组的胜算比约为0.87～0.91，且均具有统计学意义。结果的方向性与幅度在各亚组间较为一致，提示行为改善与较低医疗利用之间的关联并非由人口学或社会经济异质性所驱动。见表3。
3　讨论
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基于CHARLS五轮追踪数据，本研究识别出多病共存老年人主动健康行为的三种纵向轨迹，并进一步呈现了不同轨迹间的转移概率（如持续改善组维持率82.8%,缓慢下降组改善率6.3%），从而在纵向视角下揭示了主动健康行为的动态异质性。与既往以横断面数据为主的研究不同，本研究依托队列数据刻画个体内部随时间变化的行为模式及其演进过程，不仅验证了行为改善与医疗服务利用之间存在显著的负向梯度关系，也使关于主动健康的证据更具时间序列一致性与解释力。既往研究亦提示，社会参与水平较高者往往对应更低的医疗服务利用[16]，与本文发现相互印证。
在此基础上，LTA的应用有效识别了潜在轨迹类别及转移概率，发现长期稳定组向持续改善组的转移概率（12.5%/年）高于下降组向稳定组的转移概率（8.2%/年），表明主动健康模式之间确实存在转变，但转变并非均衡对称，而呈现一定的状态依赖特征，即较优状态更易维持，而处于不利轨迹者向更优状态转变的概率相对有限。针对转移特征的发现提示，干预策略需基于不同轨迹的可转变空间进行分层配置。一方面，应在缓慢下降组中更早识别并给予强化支持，以降低其行为改善的现实门槛；另一方面，对长期稳定组则可通过巩固关键健康行为组合、强化健康信息支持与预防服务衔接等方式，促进其向持续改善轨迹上移，从而形成更具可持续性的行为改善路径。
行为改善与医疗需求下降之间的关系，与国际上关于体力活动及健康管理与慢性病共存的研究结果总体一致[17-19]。规律体力锻炼、主动健康信息获取和健康管理行为能够改善风险暴露与自我管理能力，并在一定程度上降低长期医疗消耗。本研究的纵向发现显示，持续改善组的门诊次数、住院风险及年度医疗支出均显著低于缓慢下降组，提示积极的行为转变可能带来可量化的医疗负担减轻。这些结果为生活方式干预在缓解老龄化社会医疗资源压力方面提供了有力证据[15,20-21]。与此同时，结合转移概率结果可进一步理解上述差异的动态机制：当较高水平的主动健康行为组合能够被稳定维持或持续强化时，其在医疗利用层面的累积效应更可能得以体现；而对处于下降轨迹者而言，若缺乏持续支持，行为改善难以转化为稳定的轨迹上移，从而限制其长期获益。
此外，AHI的多维构建（Cronbach α=0.76，ICC=0.69）全面反映了老年人主动健康水平的多层面特征[22-25]。其中，规律锻炼和健康信息获取可增强疾病认知与自我管理能力，从而减少急性医疗事件；社会参与与预防服务的积极利用可提升健康意识、强化自我效能并改善健康行为依从性。这些行为因素通过促进“行为-健康-经济”良性循环，可降低慢病风险与医疗支出[26-28]。从模式转移的角度看，多维度行为的同步改善或许是轨迹上移的关键条件之一，而当部分维度受限（如健康信息获取不足或预防服务利用不足）时，行为改善可能难以形成稳定、可持续的整体提升。
分层分析进一步揭示了群体差异：女性与城镇居民中行为改善的获益更为显著。提示社会经济资源与医疗可及性可能放大主动健康行为对医疗利用的影响。相反，在慢性病负担较高的个体中，尽管行为改善仍带来方向性获益，但幅度相对减弱，说明基线疾病严重度可能限制行为改善的潜在收益[29-30]，需制定更具针对性的干预方案。
本研究亦存在一定局限。一是，由于为观测性设计无法完全排除潜在的混杂效应，因果关系仍需在未来研究中进一步验证；二是，主动健康行为指标来自自我报告法，可能存在回忆偏倚；此外，不同地区的医疗资源可及性差异也可能影响结果的普遍性。未来研究可结合随机或准实验设计，并延长随访周期，以进一步验证主动健康行为改善的因果效应与长期健康经济效益，从而为健康老龄化与医疗资源优化配置提供更坚实的证据基础。
多病共存老年人的主动健康行为呈现出明确的纵向异质性。存在持续改善、长期稳定和缓慢下降三类轨迹，且轨迹间转移概率存在差异，其中持续改善组维持率最高，缓慢下降组改善难度最大。长期稳定或改善的主动健康参与（包括锻炼、社会参与、预防性服务与健康信息获取）与较低的医疗服务利用及医疗费用显著相关。推动行为层面的健康参与，针对不同轨迹群体制定精准干预措施，有助于减轻医疗负担并支持健康老龄化政策目标。

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2026年第53卷第9期
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doi: 10.20043/j.cnki.MPM.202511375
  • 接收时间：2025-11-25
  • 首发时间：2026-11-02
  • 出版时间：2026-05-10
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    北京协和医学院 中国医学科学院 护理学院，北京 100144

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