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Article(id=1324050919880531994, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511285, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763395200000, receivedDateStr=2025-11-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607938976, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607938976, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607938976, creator=13701087609, updateTime=1793607938976, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1941, endPage=1946, ext={EN=ArticleExt(id=1324050920148967451, articleId=1324050919880531994, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The association between sunshine duration and frailty risk among middle-aged and older Chinese adults: a longitudinal analysis of CHARLS data, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the association between sunshine duration and incident frailty among middle-aged and older adults in China.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study (2011—2018), including 5 520 participants aged ≥45 years. City-level sunshine duration was obtained from the National Meteorological Science Data Center. Time-dependent Cox models were used to evaluate the association between sunshine duration and incident frailty, and restricted cubic spline and subgroup analyses were performed to assess nonlinearity and effect modification.

Results

In the fully adjusted model, each 1 h/day increase in sunshine duration was associated with a 15% higher risk of incident frailty (HR=1.15, 95% CI: 1.06-1.24, P<0.001). Restricted cubic spline analysis showed a nonlinear association, with risk increasing markedly when daily sunshine duration was ≥6.63 h/day. Subgroup analyses suggested significant effect modification by sex, education level, urban-rural residence, and work status.

Conclusion

City-level sunshine duration was associated with incident frailty among middle-aged and older adults in China, with a nonlinear pattern and higher risk mainly at higher sunshine levels.

, authors=Jie HUI1, Yan TANG2, Wei LU1, Shun ZHANG1, Zhao-hui WANG3, authorsList=Jie HUI, Yan TANG, Wei LU, Shun ZHANG, Zhao-hui WANG, authorCompany=null, correspAuthors=Zhao-hui WANG, 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=1324050921096880162, articleId=1324050919880531994, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=日照时长与中国中老年人虚弱风险的关系——基于CHARLS数据的纵向分析, 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

探讨中国中老年人群日照时长与新发虚弱风险之间的关系。

方法

基于2011—2018年中国健康与退休纵向研究，纳入5 520名45岁及以上参与者。日照时长数据来源于国家气象科学数据共享服务平台，采用时间依赖Cox回归模型评估日照时长与新发虚弱风险的关联，并采用限制性立方样条和亚组分析评估其非线性关系及效应修饰。

结果

在完全调整模型中，每增加1 h/d的日照，虚弱风险增加15%（HR=1.15，95% CI：1.06～1.24，P<0.001）。限制性立方样条分析提示日照时长与新发虚弱风险呈非线性关系，当日均日照时长约≥6.63 h后风险明显升高。亚组分析提示性别、教育水平、城乡居住地及工作状态存在显著效应修饰。

结论

城市级日照时长与中国中老年人新发虚弱风险存在关联且呈非线性特征，风险升高主要集中于较高日照区间。

, authors=惠杰1, 唐燕2, 卢伟1, 张顺1, 王朝辉3, authorsList=惠杰, 唐燕, 卢伟, 张顺, 王朝辉, authorCompany=null, correspAuthors=王朝辉, authorNote=

惠杰（2000—），男，硕士在读，研究方向：中医骨伤科学

, correspAuthorsNote=
王朝辉，E-mail：
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惠杰（2000—），男，硕士在读，研究方向：中医骨伤科学

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Innov Aging, 2025, 9(2): 62., articleTitle=Adult socioeconomic position mediates the association between childhood socioeconomic position and later-life frailty trajectory: A nationally representative cohort study, refAbstract=null)], funds=[Fund(id=1324050928726319187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, awardId=2022A1515220061, language=CN, fundingSource=广东省基础与应用基础研究基金项目(2022A1515220061), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324050921377898531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, xref=1., ext=[AuthorCompanyExt(id=1324050921386287140, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, companyId=1324050921377898531, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong 528099, China), AuthorCompanyExt(id=1324050921390481445, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, companyId=1324050921377898531, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广州中医药大学第八临床医学院，广东 佛山 528099)]), AuthorCompany(id=1324050921474367526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, xref=2., ext=[AuthorCompanyExt(id=1324050921482756135, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, companyId=1324050921474367526, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.湖南中医药大学第一附属医院)]), AuthorCompany(id=1324050923189837864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, xref=3., ext=[AuthorCompanyExt(id=1324050923198226473, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, companyId=1324050923189837864, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.佛山市中医院，广东 佛山 528099)])], figs=[ArticleFig(id=1324050925937107017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=EN, label=Figure 1, caption=Flow chart of participant screening, figureFileSmall=pSvNvxH5k1z80pWZwljz3g==, figureFileBig=mHmOjIISuFnbH6urvg472w==, tableContent=null), ArticleFig(id=1324050927619022922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=CN, label=图1, caption=参与者筛选流程图, figureFileSmall=pSvNvxH5k1z80pWZwljz3g==, figureFileBig=mHmOjIISuFnbH6urvg472w==, tableContent=null), ArticleFig(id=1324050927874875467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=EN, label=Figure 2, caption=Restricted cubic spline plot of sunshine duration and frailty, figureFileSmall=SA7fu9kRi+LzSj/jNDlGmg==, figureFileBig=U8DlrRy0vhFh1Xz+1us/rw==, tableContent=null), ArticleFig(id=1324050928009093196, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=CN, label=图2, caption=日照时长与虚弱的RCS图

注：校正了年龄、教育水平、性别、家庭人均消费、婚姻状况、居住地、吸烟、饮酒、工作状态、调查月份固定效应，以及城市层面环境因素（高温天数、PM2.5、O3、年总太阳辐射）。

, figureFileSmall=SA7fu9kRi+LzSj/jNDlGmg==, figureFileBig=U8DlrRy0vhFh1Xz+1us/rw==, tableContent=null), ArticleFig(id=1324050928097173581, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=EN, label=Figure 3, caption=Subgroup analysis of sunshine duration and frailty, figureFileSmall=j24pmvz4f1RevwjWGIa8Pw==, figureFileBig=JrZwUpiknJ8Xug9leoawNQ==, tableContent=null), ArticleFig(id=1324050928168476750, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=CN, label=图3, caption=日照时长与虚弱的亚组分析

注：校正了年龄、教育水平、性别、家庭人均消费、婚姻状况、居住地、吸烟、饮酒、工作状态、调查月份固定效应，以及城市层面环境因素（高温天数、PM2.5、O3、年总太阳辐射）。

, figureFileSmall=j24pmvz4f1RevwjWGIa8Pw==, figureFileBig=JrZwUpiknJ8Xug9leoawNQ==, tableContent=null), ArticleFig(id=1324050928243974223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050919880531994, language=EN, label=Table 1, caption=

Baseline characteristics of the study population ［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群(n=5 520)未虚弱组(n=4 287)虚弱组（n=1 233)P值
年龄（岁）56(49, 62)55(49, 61)59(53, 65)<0.001
性别<0.001
女2 772(50.2)2 030(47.4)742 (60.2)
男2 748(49.8)2 257(52.6)491 (39.8)
婚姻0.003
其他431(7.8)310(7.2)121(9.8)
已婚5 089(92.2)3 977(92.8)1 112(90.2)
教育<0.001
小学以下2 109(38.2)1 456(34.0)653(53.0)
小学1 208(21.9)929(21.7)279(22.6)
中学1 364(24.7)1 170(27.3)194(15.7)
高中及以上839(15.2)732(17.1)107(8.7)
居住地<0.001
城市2 201(39.9)1 829(42.7)372(30.2)
农村3 319(60.1)2 458(57.3)861(69.8)
家庭人均消费（ln）8.56(8.02, 9.14)8.60(8.06, 9.18)8.46(7.95, 8.97)<0.001
吸烟0.002
从不3 281(59.4)2 502(58.4)779(63.2)
吸过2 239(40.6)1 785(41.6)454(36.8)
饮酒<0.001
从不3 766(68.2)2 837(66.2)929(75.3)
偶尔460(8.3)388(9.1)72(5.8)
经常1 294(23.4)1 062(24.8)232(18.8)
工作<0.001
农业工作2 243(40.6)1 670(39.0)573(46.5)
非农业工作1 593(28.9)1 401(32.7)192(15.6)
未工作1 684(30.5)1 216(28.4)468(38.0)
肝脏疾病0.002
否5 333(96.6)4 159(97.0)1 174(95.2)
是187(3.4)128(3.0)59(4.8)
肾脏疾病<0.001
否5 259(95.3)4 131(96.4)1 128(91.5)
是261(4.7)156(3.6)105(8.5)
高温暴露天数（d）12(0,25)12(0,25)10(0,25)0.008
PM2.5（μg/m3）54.28 (42.21, 67.45)54.91 (42.23, 67.45)52.21 (41.43, 67.45)0.123
O3（μg/m3）83.19 (79.45, 88.05)83.66 (79.54, 88.05)82.06 (78.81, 86.71)<0.001
太阳辐射（MJ/m2）5 451.56 (5 121.74, 5 740.08)5 455.15 (5 132.20, 5 740.08)5 407.52 (5 002.96, 5 706.24)<0.001
日照时长（h/d）5.65 (4.62, 6.44)5.65 (4.63, 6.37)5.70 (4.26, 6.52)0.472
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纳入人群的临床特征［M（P25，P75），n（%）］

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变量总人群(n=5 520)未虚弱组(n=4 287)虚弱组（n=1 233)P值
年龄（岁）56(49, 62)55(49, 61)59(53, 65)<0.001
性别<0.001
女2 772(50.2)2 030(47.4)742 (60.2)
男2 748(49.8)2 257(52.6)491 (39.8)
婚姻0.003
其他431(7.8)310(7.2)121(9.8)
已婚5 089(92.2)3 977(92.8)1 112(90.2)
教育<0.001
小学以下2 109(38.2)1 456(34.0)653(53.0)
小学1 208(21.9)929(21.7)279(22.6)
中学1 364(24.7)1 170(27.3)194(15.7)
高中及以上839(15.2)732(17.1)107(8.7)
居住地<0.001
城市2 201(39.9)1 829(42.7)372(30.2)
农村3 319(60.1)2 458(57.3)861(69.8)
家庭人均消费（ln）8.56(8.02, 9.14)8.60(8.06, 9.18)8.46(7.95, 8.97)<0.001
吸烟0.002
从不3 281(59.4)2 502(58.4)779(63.2)
吸过2 239(40.6)1 785(41.6)454(36.8)
饮酒<0.001
从不3 766(68.2)2 837(66.2)929(75.3)
偶尔460(8.3)388(9.1)72(5.8)
经常1 294(23.4)1 062(24.8)232(18.8)
工作<0.001
农业工作2 243(40.6)1 670(39.0)573(46.5)
非农业工作1 593(28.9)1 401(32.7)192(15.6)
未工作1 684(30.5)1 216(28.4)468(38.0)
肝脏疾病0.002
否5 333(96.6)4 159(97.0)1 174(95.2)
是187(3.4)128(3.0)59(4.8)
肾脏疾病<0.001
否5 259(95.3)4 131(96.4)1 128(91.5)
是261(4.7)156(3.6)105(8.5)
高温暴露天数（d）12(0,25)12(0,25)10(0,25)0.008
PM2.5（μg/m3）54.28 (42.21, 67.45)54.91 (42.23, 67.45)52.21 (41.43, 67.45)0.123
O3（μg/m3）83.19 (79.45, 88.05)83.66 (79.54, 88.05)82.06 (78.81, 86.71)<0.001
太阳辐射（MJ/m2）5 451.56 (5 121.74, 5 740.08)5 455.15 (5 132.20, 5 740.08)5 407.52 (5 002.96, 5 706.24)<0.001
日照时长（h/d）5.65 (4.62, 6.44)5.65 (4.63, 6.37)5.70 (4.26, 6.52)0.472
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Cox regression analysis of sunshine duration and frailty

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Variables模型 1模型 2模型 3
HR(95%CI)P值HR(95%CI)P值HR(95%CI)P值
每增加1h/d0.99(0.95～1.04)0.7421.04(1.00～1.09)0.0731.15(1.06～1.24)<0.001
Q1RefRefRef
Q20.65(0.55～0.77)<0.0010.69(0.59～0.81)<0.0010.85(0.69～1.04)0.111
Q30.77(0.66～0.91)0.0020.89(0.76～1.05)0.1791.21(0.93～1.56)0.152
Q41.07(0.93～1.24)0.3401.24(1.08～1.43)0.0031.51(1.17～1.95)0.002
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日照时长与虚弱的Cox回归分析

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Variables模型 1模型 2模型 3
HR(95%CI)P值HR(95%CI)P值HR(95%CI)P值
每增加1h/d0.99(0.95～1.04)0.7421.04(1.00～1.09)0.0731.15(1.06～1.24)<0.001
Q1RefRefRef
Q20.65(0.55～0.77)<0.0010.69(0.59～0.81)<0.0010.85(0.69～1.04)0.111
Q30.77(0.66～0.91)0.0020.89(0.76～1.05)0.1791.21(0.93～1.56)0.152
Q41.07(0.93～1.24)0.3401.24(1.08～1.43)0.0031.51(1.17～1.95)0.002
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日照时长与中国中老年人虚弱风险的关系——基于CHARLS数据的纵向分析
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惠杰 1 , 唐燕 2 , 卢伟 1 , 张顺 1 , 王朝辉 3
现代预防医学 | 流行病与统计方法 2026,53(11): 1941-1946
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现代预防医学 |流行病与统计方法 2026 , 53 (11) : 1941 -1946
日照时长与中国中老年人虚弱风险的关系——基于CHARLS数据的纵向分析
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惠杰1, 唐燕2, 卢伟1, 张顺1, 王朝辉3
作者信息
  • 1.广州中医药大学第八临床医学院，广东 佛山 528099
  • 2.湖南中医药大学第一附属医院
  • 3.佛山市中医院，广东 佛山 528099
通讯作者:
王朝辉，E-mail：
作者简介:

惠杰（2000—），男，硕士在读，研究方向：中医骨伤科学

The association between sunshine duration and frailty risk among middle-aged and older Chinese adults: a longitudinal analysis of CHARLS data
Jie HUI1, Yan TANG2, Wei LU1, Shun ZHANG1, Zhao-hui WANG3
Affiliations
  • The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong 528099, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202511285
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摘要
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目的

探讨中国中老年人群日照时长与新发虚弱风险之间的关系。

方法

基于2011—2018年中国健康与退休纵向研究，纳入5 520名45岁及以上参与者。日照时长数据来源于国家气象科学数据共享服务平台，采用时间依赖Cox回归模型评估日照时长与新发虚弱风险的关联，并采用限制性立方样条和亚组分析评估其非线性关系及效应修饰。

结果

在完全调整模型中，每增加1 h/d的日照，虚弱风险增加15%（HR=1.15，95% CI：1.06～1.24，P<0.001）。限制性立方样条分析提示日照时长与新发虚弱风险呈非线性关系，当日均日照时长约≥6.63 h后风险明显升高。亚组分析提示性别、教育水平、城乡居住地及工作状态存在显著效应修饰。

结论

城市级日照时长与中国中老年人新发虚弱风险存在关联且呈非线性特征，风险升高主要集中于较高日照区间。

日照  /  虚弱  /  中国健康与退休纵向研究（CHARLS）
Objective

To examine the association between sunshine duration and incident frailty among middle-aged and older adults in China.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study (2011—2018), including 5 520 participants aged ≥45 years. City-level sunshine duration was obtained from the National Meteorological Science Data Center. Time-dependent Cox models were used to evaluate the association between sunshine duration and incident frailty, and restricted cubic spline and subgroup analyses were performed to assess nonlinearity and effect modification.

Results

In the fully adjusted model, each 1 h/day increase in sunshine duration was associated with a 15% higher risk of incident frailty (HR=1.15, 95% CI: 1.06-1.24, P<0.001). Restricted cubic spline analysis showed a nonlinear association, with risk increasing markedly when daily sunshine duration was ≥6.63 h/day. Subgroup analyses suggested significant effect modification by sex, education level, urban-rural residence, and work status.

Conclusion

City-level sunshine duration was associated with incident frailty among middle-aged and older adults in China, with a nonlinear pattern and higher risk mainly at higher sunshine levels.

Sunshine  /  Frailty  /  China Health and Retirement Longitudinal Study (CHARLS)
惠杰, 唐燕, 卢伟, 张顺, 王朝辉. 日照时长与中国中老年人虚弱风险的关系——基于CHARLS数据的纵向分析. 现代预防医学, 2026 , 53 (11) : 1941 -1946 . DOI: 10.20043/j.cnki.MPM.202511285
Jie HUI, Yan TANG, Wei LU, Shun ZHANG, Zhao-hui WANG. The association between sunshine duration and frailty risk among middle-aged and older Chinese adults: a longitudinal analysis of CHARLS data[J]. Modern Preventive Medicine, 2026 , 53 (11) : 1941 -1946 . DOI: 10.20043/j.cnki.MPM.202511285
正文
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中国作为全球人口最多的国家，正快速步入老龄社会。预计到2050年，65岁及以上人群将占总人口的26.1%[1]。虚弱是一种临床脆弱状态，表现为生理储备减少、对压力源的抵抗力减弱，并伴随不良健康结局风险升高[2]。其不仅增加了跌倒和死亡等不良健康结局的易感性[3]，还与更高的医疗保健成本相关[4]。据调查，中国社区居住的中老年群体中，虚弱的患病率已从2011年的13.5%上升至2020年的16.3%[5]。鉴于虚弱具有一定可逆性，可通过干预延缓，因此识别相关风险因素至关重要。
日照是一项重要的环境暴露因素。既往研究显示适度的日照与多方面健康获益相关，涉及骨骼、心理与内分泌代谢等领域[6]；另一方面，日照对健康可能存在一定风险，其人群效应可能受暴露强度与情境影响，因此有必要进一步界定何种水平和情境的日照更值得关注[7]。目前研究多采用自报日晒等指标，其测量精度有限，同时，不少研究为横断面设计，因果方向难以明确，不同地区与生活方式背景下结论存在差异[8]。尤其在中国情境下，关于日照与中国中老年人虚弱之间的关系，仍缺乏系统的纵向研究。
因此本研究基于中国健康与退休纵向研究（China Health and Retirement Longitudinal Study，CHARLS）的全国代表性数据，采用时间依赖Cox回归模型评估城市级日照时长与中国中老年人虚弱风险的关系，为理解日照时长对中老年人健康的长期影响提供科学依据。
1　对象与方法
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1.1　数据来源
本研究数据来源于中国健康与退休纵向研究，该研究由北京大学国家发展研究院主导[9]，通过在28个省份150个县的多阶段、分层、聚类抽样，旨在评估45岁及以个体的健康状况、社会经济和人口学特征。研究自2011年启动，并于2013、2015、2018和2020年开展随访。所有研究程序均已获得北京大学生物医学伦理委员会的伦理批准（批准号：IRB00001052–11015），并且所有参与者都签署了知情同意书。
在本研究共计纳入25 584名参与者，依次排除：（1）基线已虚弱或基线虚弱状态缺失者；（2）缺失基线关键协变量者（性别、教育、婚姻状况、城乡居住地）；不满足具有基线且至少1次随访或基线后死亡信息的参与者；（3）在进行变量填充后仍存在缺失者。最终纳入5 520名参与者，见图1。在缺失值处理方面，若基线关键变量如性别、教育、婚姻状况、城乡居住地缺失，则参照其他波次的已观测信息进行补齐：对慢性病史或长期行为变量如肝脏疾病、肾脏疾病、吸烟、饮酒，仅在非基线波次缺失且缺失率较低时采用最后观测值向前填补法。
1.2　暴露和结局变量
本研究以城市层面的日照时长作为暴露变量。日照时长指在无遮蔽条件下，太阳自东方升起至西方落下过程中，其光照到达地面的累计时间，单位为小时（h）。暴露数据来源于国家气象科学数据共享服务平台发布的《中国地面气候资料日值数据集（V3.0）》（https://data.cma.cn/），该数据基于全国地面气象站观测并经汇总整理。日照时长作为反映地区光照条件的客观气象指标，在既往环境与健康研究中常被用于表征长期环境光照暴露水平，并用于评估与健康结局的关联[10]。本研究采用各城市年度日照时长（h/年），为便于解释，进一步折算为城市日均日照时长（h/d）。考虑潜在滞后效应的影响，分析采用前一年度的日均日照时长作为该随访波次的暴露值，并依据参与者所属城市与CHARLS数据进行匹配。
本研究采用虚弱指数（frailty index）评估虚弱状态，虚弱指数通过整合多种与衰老相关的健康缺陷，相比实际年龄或生物学年龄更能预测不良结局[11]。共选择了32个项目来构建虚弱指数[12]，覆盖合并症、身体机能、抑郁和认知等主要健康维度[13-14]。虚弱指数通过将32项健康缺陷的得分求和后除以评估项目总数计算得到，总分范围为0～1，分值越高代表虚弱程度越重。为便于结果解释及与既往研究保持可比性，本研究将虚弱指数<0.25 定义为非虚弱，将虚弱指数≥0.25 定义为虚弱[15]。
1.3　协变量
参照既往研究[16-17]，本研究纳入了潜的在混杂因素，以确保模型的稳健性。人口学特征包括年龄、性别、婚姻状况（已婚或其他）；社会经济因素包括教育水平（小学以下、小学、中学、高中及以上）、居住地（城市或农村）、家庭人均消费（取自然对数）；健康行为因素包括吸烟状态（吸过烟或没有吸过烟）、饮酒状态（从不、偶尔、经常）；健康状况因素涵盖肝脏疾病及肾脏疾病（是或否），并结合工作情况（农业工作、非农业工作、未工作）作为与职业性户外暴露相关指标。同时为控制环境与季节性混杂，纳入气候环境指标包括高温暴露（一年中气温超过当年全国第95百分位阈值、且连续持续2天及以上的热浪天数）、PM2.5、O3、年总太阳辐射量，并将调查月份作为分类变量纳入模型。PM2.5与O3使用中国高分辨率高质量近地表空气污染物数据集提供的城市年均浓度；太阳辐射使用基于ERA5-Land 的1 km分辨率逐年太阳辐射数据；热浪指标使用基于中国气象数据中心逐日气温数据、采用分位阈值与持续日数法识别并汇总得到的热浪数据。
1.4　统计方法
基线特征按随访期间是否发生虚弱进行分组展示。连续型变量以中位数及四分位数间距描述，组间差异采用 Wilcoxon 秩和检验评估；分类变量以频数（n）和百分比（%）表示，组间差异采用χ2检验评估。构建时间依赖 Cox 比例风险模型，以2011年基线调查为时间起点，按照相邻两次调查时间构建个体风险区间。结局定义为随访期间受试者首次新发虚弱事件。对于随访过程中死亡者，将死亡作为删失处理：若死亡发生于某一风险区间内，则将该区间终点截断至死亡时间。每个日照时长及其他协变量的取值均为当期测量值。
构建三套模型：模型1不做调整；模型2调整人口学变量（年龄、性别、教育）；模型3在模型2基础上进一步调整家庭人均消费、吸烟、饮酒、婚姻、城乡、肝脏疾病、肾脏疾病及工作情况，并纳入环境因素（高温暴露、PM2.5、O3、年总辐射）与调查月份固定效应。将日照时长按四分位数分组并在相同时间依赖Cox框架下拟合未调整、部分调整与完全调整模型，比较各分组的风险比（hazard ratio，HR）及95% CI（95% confidence interval，95% CI）。比例风险假设通过Schoenfeld残差检验评估。在完全调整模型基础上采用限制性立方样条（restricted cubic spline，RCS）对日照时长建模，设置4个结点（分位点为第5%、35%、65%和95%）；以5 h/d作为参照值绘制暴露-反应曲线。利用似然比检验比较线性模型与样条模型的拟合优度。亚组分析按年龄、性别、婚姻状况、居住地、教育水平、吸烟状态、饮酒状态和工作状态分层拟合完全调整模型，并通过Wald检验评估交互作用。
最后，通过敏感性分析验证主要研究结论的稳健性。（1）构建城市层面夏季（6～8月）与冬季（12～2月）日均日照时长指标；（2）进一步纳入调查年份固定效应；（3）排除随访早期（≤2年）发生新发虚弱的参与者；（4）对睡眠时长进行额外调整：①将睡眠时长以限制性样条形式纳入模型；②将睡眠时长按分类变量（≤6 h、6～8 h、≥8 h）纳入模型；（5）不进行缺失值填补。
所有统计分析与图表绘制均使用R软件（版本4.3.2）完成，检验水准α=0.05。
2　结果
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2.1　研究对象的基本特征
纳入分析的5 520名参与者的基线特征见表1。共随访31 452.17人年，发生新发虚弱1 233例，总体发病率为39.2/1 000人年。研究对象覆盖全国28个省份的125个地级市，基线匹配的城市日均日照时长中位数为5.65 h，四分位数分组的切点：Q1为2.44～<4.62h、Q2为4.62～<5.65h、Q3为5.65～<6.44h、Q4为6.44～<8.02 h，各组样本量分别为1 434、1 340、1 377和1 369人。与未发生新发虚弱者相比，发生新发虚弱者年龄更大、女性比例更高、教育程度较低，非已婚与农村居住比例更高，家庭人均消费水平更低；吸烟、饮酒与工作类型分布差异显著，肝脏疾病与肾脏疾病比例更高；在环境因素方面，高温天数、O3及年总辐射的分布差异具有统计学意义。
2.2　日照时长与虚弱风险的关系
时间依赖Cox比例风险回归结果显示，日均日照时长与虚弱发生风险呈正相关，见表2。在连续暴露性中，未调整模型（模型1）日照时长 与新发虚弱风险关联不显著。在调整年龄、性别与教育水平后（模型2），关联方向转为正向但未达统计学显著。在进一步控制社会经济因素、健康行为与工作情况、既往疾病以及环境与季节因素后（模型3），日照时长 与新发虚弱风险呈显著正相关（HR=1.15），提示日均日照时长每增加1 h/d，新发虚弱风险增加约15%。进一步按基线日均日照时长四分位分组，在完全调整模型中，Q4组与更高的新发虚弱风险相关（HR=1.51）。该分组结果提示风险升高主要出现在较高日照时长水平。
Schoenfeld 残差检验结果表明，在完全调整模型中暴露项均未见违反比例风险假设，全局检验提示部分协变量可能存在随时间变化的效应。在对工作状态、肝脏疾病和肾脏疾病采用分层 Cox 模型进行控制后，全局检验不再提示明显的比例风险偏离，提示本研究的主要结论具有良好的稳健性。
RCS拟合的剂量-反应关系见图2。结果提示两者存在显著非线性关联。以5h/d为参照，较低日照时长范围内风险未见明显变化；当日均日照时长增加至约6.63h及以上时，风险显著升高。进一步报告典型点位对比：3 h的HR为0.97，而7 h的HR为1.39。提示风险升高主要集中于较高日照时长区间，与四分位分析的结果一致。
敏感性分析进一步验证了结果的稳健性，在纳入调查年份固定效应后，日照时长每增加1h/d的HR为1.15，Q4组相较Q1组的HR为1.49。排除随访早期发生新发虚弱的参与者后，日照时长每增加1h/d的HR为1.13，Q4组相较Q1组的HR为1.46。采用夏季日均日照时长时长作为暴露时，日照时长每增加1h/d的HR为1.14，Q4组相较Q1组的HR为1.30。进一步加入睡眠变量后，日照时长每增加1 h/d的HR为1.15，Q4组相较Q1组的HR为1.51。此外，采用不进行缺失值填补分析的结果也显示日照时长每增加1 h/d的HR为1.15，Q4组相较Q1组的HR为1.50。
2.3　亚组分析
亚组分析的结果见图3。在预设的人群特征下，日照时长与新发虚弱风险的关联方向总体一致，多数亚组呈风险升高趋势。交互作用检验提示性别、教育水平、居住地及工作状态可能对该关联存在效应修饰。而年龄、婚姻状况、吸烟及饮酒状态的交互作用检验均未达到统计学显著。除此之外，我们在各亚组内采用RCS绘制日照-虚弱风险曲线，结果显示，各亚组的风险升高主要集中于较高日照区间（约≥6 h/d），总体曲线形态相近。
3　讨论
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本研究基于中国中老年人群的CHARLS纵向数据，首次探讨了城市级日照时长与新发虚弱风险之间的关系。研究结果表明，日照时长与虚弱风险之间存在显著非线性关联。在中等日照范围内风险相对平稳，而当日均日照达到较高水平后风险上升明显，提示城市层面较高日照时长可能是值得关注的环境风险特征之一。值得注意的是，未调整模型中日照与虚弱关联不显著，在充分控制混杂因素后，日照时长与虚弱风险的独立关联才更清晰，提示粗模型可能受到与虚弱密切相关的个体特征与环境因素混杂的影响。既往关于日照与健康结局的研究总体呈现双向证据，不同研究在暴露测量、混杂控制策略上差异较大，因此不同研究之间更容易出现结论差异[18]。
在部分研究中，自报的低日晒暴露被识别为虚弱的相关因素之一[19]，在更广泛的健康结局上，研究显示回避日照与更高全因死亡风险相关[20]。也有研究说明较短日照时长与心血管疾病风险增加相关[10]。而适度的日照暴露已被证明能改善多个代谢参数，包括葡萄糖调节、促进脂肪氧化等[21]。但同时，也有研究在高日照暴露情境下观察到潜在不利效应，过长日照与院外心搏骤停风险升高相关，且在时间序列研究中日照与急性心肌梗死住院呈U形关系，说明极端日照水平更具健康风险[22-23]。中国一项省级日照的研究也报告了地区日照时长增加与死亡率上升呈正相关[24]。机制层面，维生素D相关通路可能参与解释日照与虚弱的非线性特征，皮肤日照是维持循环25(OH)D稳态的主要来源之一[25]，研究表明25(OH)D水平与虚弱呈非线性关系：无论基线水平低于20 ng/mL，还是高于30 ng/ml，均与更高的虚弱发生风险相关[26]。此外，当日照暴露超过一定阈值时，可诱导皮肤及全身氧化应激和免疫调控改变，从而促进慢性低度炎症，而慢性炎症标志物与虚弱的发生和进展密切相关[27]。因此，既往研究证据并非单向一致，而是表明日照时长在不同强度与暴露情境下可能同时具有潜在获益与风险。
亚组分析提示性别、教育水平、城乡居住地及工作状态对日照时长与虚弱关联可能存在效应修饰，既往全国代表性样本的研究表明，我国中老年人虚弱在女性、低教育及农村居住者中更为常见，并存在明显的社会与地区差异，健康资源的可及性与生活方式的差异可能影响虚弱的发生[28-29]。城乡居住地与教育等社会经济因素与虚弱转归密切相关，因此需关注社会脆弱人群的差异化健康风险[30]。本研究的结果对公共卫生政策具有重要的启示意义。在较高水平长期日照背景下，中老年人群可能面临更高的环境负荷，因此应在高日照时段减少户外停留并采取有效的物理遮蔽等措施，尤其应关注农村与户外工作人群等潜在高风险群体。
本研究具有一定优势：首先，基于全国代表性纵向样本，为结果的稳健性提供了较强支撑；其次，采用时间依赖Cox模型，可以更好地刻画暴露与协变量的动态变化；最后，多项敏感性分析验证了主要结论的稳健性。本研究仍存在一定局限：一是，作为观察性研究，难以完全排除残余混杂；二是，由于CHARLS数据库变量的限制，无法完全区分个体实际户外日照时长与城市级别日照之间的差异，可能导致非差异性暴露错分，从而使关联估计偏向零效应。
总之，本研究表明，日照时长与虚弱风险之间存在显著的正向关联，并呈现非线性特征，在高日照水平下虚弱风险明显增加。未来研究需进一步阐明不同强度与时间结构的日照时长对虚弱发生和进展的长期影响，以期为高风险人群制定更详细的健康建议。
基金
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  • 广东省基础与应用基础研究基金项目(2022A1515220061)
文献
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202511285
  • 接收时间：2025-11-18
  • 首发时间：2026-11-02
  • 出版时间：2026-06-10
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  • 收稿日期：2025-11-18
基金
广东省基础与应用基础研究基金项目(2022A1515220061)
作者信息
    1.广州中医药大学第八临床医学院，广东 佛山 528099
    2.湖南中医药大学第一附属医院
    3.佛山市中医院，广东 佛山 528099

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