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Article(id=1324077660007182630, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509503, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1759075200000, receivedDateStr=2025-09-29, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614314319, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614314319, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614314319, creator=13701087609, updateTime=1793614314319, updator=13701087609, issue=Issue{id=1324077560820282023, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614290671, creator='13701087609', updateTime=1793614391469, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077983656444429, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077983660638734, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1055, endPage=1061, ext={EN=ArticleExt(id=1324077660229480743, articleId=1324077660007182630, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of factors associated with low health literacy among residents: the impact and interaction of age, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the impact of age on low health literacy level among residents in Fuyang District of Hangzhou, and to elucidate its interactive effect with other determinants.

Methods

A questionnaire survey was conducted among residents aged 15-69 years old by multi-stage stratified random sampling. Data on basic demographic characteristics and health literacy levels were collected. The associations were examined using the Mann-Whitney U test, Chi-square test, the restricted cubic splines (RCS) model, and multivariable-adjusted logistic regression models.Furthermore, multiplicative and additive interaction models were applied to explore the joint effects of age and other influencing factors on low health literacy.

Results

Among the 640 respondents, 417 (65.16%) had a low health literacy level. After adjusting for potential confounders, the RCS model revealed a significant nonlinear dose-response relationship between age and the risk of low health literacy (Pnonlinear<0.01), with an inflection point at 51 years old. Subsequently, multivariate logistic regression analysis using this cut-off value demonstrated that individuals aged over 51 years old had a significantly higher risk of low health literacy (OR=3.377, 95% CI: 2.120-5.378, P<0.05). Regarding interaction effects, an additive interaction was observed between age and educational level (RERI=9.979, 95% CI: 0.389-19.569; AP=0.606, 95% CI: 0.368-0.843; SI=2.814, 95% CI: 1.442-5.492).

Conclusion

Age is an independent influencing factor of low health literacy levels among residents. Further interaction analysis reveals that individuals with advanced age and low educational attainment are identified as the key target population for health literacy promotion and intervention efforts.

, authors=Wei ZHAO1, 2, Dan-ni HUANG2, Bi-qi SHOU2, Xing-juan YAO1, authorsList=Wei ZHAO, Dan-ni HUANG, Bi-qi SHOU, Xing-juan YAO, authorCompany=null, correspAuthors=Xing-juan 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=1324077662079168812, articleId=1324077660007182630, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=年龄对居民低健康素养水平的影响及交互作用分析, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

了解年龄对杭州市富阳区居民低健康素养水平的影响，并探究其与其他影响因素间的交互作用。

方法

采用分层多阶段随机抽样法抽取该区15~69周岁常住居民进行健康素养问卷调查，收集基本人口学信息和健康素养水平。采用限制性立方样条（RCS）模型和logistic回归模型分析年龄与居民低健康素养水平的关联，并进一步应用相乘、相加交互作用模型探索年龄与其他影响因素对居民低健康素养水平的联合作用。

结果

640名调查对象中，低健康素养水平居民417名（65.16%）。RCS曲线显示，调整混杂因素后，年龄和居民低健康素养水平呈非线性剂量-反应关系（Pnonlinear<0.01），确定拐点为51岁，并以此为界纳入多因素logistic回归中结果显示，年龄>51岁组（OR=3.377, 95% CI: 2.120~5.378）与居民低健康素养水平相关（P<0.05）。交互作用结果显示，年龄和文化程度存在相加交互作用（RERI=9.979, 95% CI: 0.389~19.569; AP=0.606, 95% CI: 0.368~0.843; SI=2.814, 95% CI: 1.442~5.492）。

结论

高龄（51岁）是居民低健康素养水平的重要影响因素，进一步交互作用分析提示高龄且低文化程度人群是健康素养工作关注和干预的重点对象。

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赵薇（1997—），女，硕士在读，医师，研究方向：公共卫生

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姚杏娟，E-mail:
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(In Chinese), articleTitle=Research onethical issues and countermeasures of the digital divide among the elderly group in health communication, refAbstract=null), Reference(id=1324077670727823745, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, doi=null, pmid=null, pmcid=null, year=2025, volume=25, issue=null, pageStart=1, pageEnd=16, url=null, language=null, rfNumber=[25], rfOrder=35, authorNames=宋小康, 李芬, 赵宇翔, journalName=图书馆杂志, refType=null, unstructuredReference=宋小康，李芬，赵宇翔，等．健康信息替代搜寻中代际支持对老年人多维健康素养影响机理的组态分析[J]．图书馆杂志，2025，25：1-16．, articleTitle=健康信息替代搜寻中代际支持对老年人多维健康素养影响机理的组态分析, refAbstract=null), Reference(id=1324077670820098435, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, doi=null, pmid=null, pmcid=null, year=2025, volume=25, issue=null, pageStart=1, pageEnd=16, url=null, language=null, rfNumber=[25], rfOrder=36, authorNames=Song XK, Li F, Zhao YX, journalName=Library Journal, refType=null, unstructuredReference=Song XK, Li F, Zhao YX, et al. 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(In Chinese), articleTitle=Configuration analysis of the mechanism of intergenerational support on multidimensional health literacy of the elderly in the context of surrogate health information seeking, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077662364381485, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, xref=1., ext=[AuthorCompanyExt(id=1324077662372770094, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, companyId=1324077662364381485, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China), AuthorCompanyExt(id=1324077662381158703, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, companyId=1324077662364381485, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京医科大学公共卫生学院，江苏 南京 211166)]), AuthorCompany(id=1324077662465044784, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, xref=2., ext=[AuthorCompanyExt(id=1324077662473433393, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, companyId=1324077662465044784, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.杭州市富阳区疾病预防控制中心（杭州市富阳区卫生监督所）健康教育和慢性病管理科)])], figs=[ArticleFig(id=1324077664599945551, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Fig.1, caption=Dose-response relationship between age and risk of low health literacy, figureFileSmall=VFUPbLNpPBOhrE2fsy7XtA==, figureFileBig=J3KYDJvpWD9ay8HShox8nw==, tableContent=null), ArticleFig(id=1324077664738357584, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=图1, caption=年龄与居民低健康素养水平的剂量-反应关系曲线

注：阴影区域代表95%置信区间；A 粗模型；B 调整居住地、户籍、性别、民族、文化程度、婚姻情况、职业、家庭人均年收入、是否吸烟、是否接触二手烟、有无慢性病、过去1年自付医疗费用。

, figureFileSmall=VFUPbLNpPBOhrE2fsy7XtA==, figureFileBig=J3KYDJvpWD9ay8HShox8nw==, tableContent=null), ArticleFig(id=1324077664973238609, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Fig.2, caption=Subgroup analysis of the association between age groups and low health literacy, figureFileSmall=YYE+A0XcAnZ9F9xLqzSM1w==, figureFileBig=JTw3H8RNrX/iBXR9e6O6Wg==, tableContent=null), ArticleFig(id=1324077665161982290, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=图2, caption=年龄与居民低健康素养水平关系的亚组分析, figureFileSmall=YYE+A0XcAnZ9F9xLqzSM1w==, figureFileBig=JTw3H8RNrX/iBXR9e6O6Wg==, tableContent=null), ArticleFig(id=1324077665262645587, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Table 1, caption=

Variable assignment

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容赋值
年龄（岁）连续变量，按照实际值，范围为15~69岁
居住地1=城市；2=农村
户籍1=本地；2=其他
性别1=男；2=女
民族1=汉族；2=其他
文化程度1=初中及以下；2=初中以上[16]
婚姻情况1=未婚；2=在婚；3=分居、离异、丧偶[4]
职业1=公务员/教师/医务人员/其他事业单位人员；2=学生；3=农民/工人；4=其他企业人员；5=其他[9]
家庭人均年收入（元）1=<30 000；2=≥30 000[9]
是否吸烟0=以前吸，现在不吸/从不吸烟；1=每天吸/吸，但不是每天
是否接触二手烟0=不接触；1=接触
有无慢性病0=无；1=有
过去1年自付医疗费用（元）1=<1 000；2=1 000~2 999；3=≥3 000[4]
低健康素养水平0=否；1=是
), ArticleFig(id=1324077665346531668, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=表1, caption=

变量赋值表

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容赋值
年龄（岁）连续变量，按照实际值，范围为15~69岁
居住地1=城市；2=农村
户籍1=本地；2=其他
性别1=男；2=女
民族1=汉族；2=其他
文化程度1=初中及以下；2=初中以上[16]
婚姻情况1=未婚；2=在婚；3=分居、离异、丧偶[4]
职业1=公务员/教师/医务人员/其他事业单位人员；2=学生；3=农民/工人；4=其他企业人员；5=其他[9]
家庭人均年收入（元）1=<30 000；2=≥30 000[9]
是否吸烟0=以前吸，现在不吸/从不吸烟；1=每天吸/吸，但不是每天
是否接触二手烟0=不接触；1=接触
有无慢性病0=无；1=有
过去1年自付医疗费用（元）1=<1 000；2=1 000~2 999；3=≥3 000[4]
低健康素养水平0=否；1=是
), ArticleFig(id=1324077665447194965, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Table 2, caption=

Low health literacy levels of residents with different demographic characteristics in Fuyang District, Hangzhou, 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容总人群(n=640)高健康素养水平(n=223)低健康素养水平(n=417)Z/χ2值P值
年龄[岁，M(P25, P75)]51.00(41.00，58.75)43.00(34.00，51.00)55.00(48.00，61.00)-11.450<0.001
居住地[n(%)]35.846<0.001
城区160(25.00)87(39.01)73(17.51)
农村480(75.00)136(60.99)344(82.49)
户籍[n(%)]0.0100.921
本地612(95.63)213(95.52)399(95.68)
其他28(4.38)10(4.48)18(4.32)
性别[n(%)]0.0460.831
男312(48.75)110(49.33)202(48.44)
女328(51.25)113(50.67)215(51.56)
民族[n(%)]0.3040.179
汉族636(99.38)223(100.00)413(99.04)
其他4(0.63)0(0)4(0.96)
文化程度[n(%)]153.748<0.001
初中及以下380(59.38)59(26.46)321(76.98)
初中以上260(40.61)164(73.54)96(23.02)
婚姻情况[n(%)]13.2230.001
未婚61(9.53)34(15.25)27(6.47)
在婚523(81.72)169(75.78)354(84.89)
分居/离异/丧偶56(8.75)20(8.97)36(8.63)
职业[n(%)]108.280<0.001
公务员/教师/医务人员/其他事业单位人员74(11.56)51(22.87)23(5.52)
学生14(2.19)8(3.59)6(1.44)
农民/工人350(54.69)63(28.25)287(68.82)
其他企业人员143(22.34)77(34.53)66(15.83)
其他59(9.22)24(10.76)35(8.39)
家庭人均年收入[元，n(%)]68.826<0.001
<30 000331(51.72)65(29.15)266(63.79)
≥30 000309(48.28)158(70.85)151(36.21)
是否吸烟[n(%)]0.9790.322
是176(27.50)56(25.11)120(28.78)
否464(72.50)167(74.89)297(71.22)
是否接触二手烟[n(%)]0.7070.400
是350(54.69)127(56.95)223(53.48)
否290(45.31)96(43.05)194(46.52)
有无慢性病[n(%)]26.169<0.001
有170(26.56)32(14.35)138(33.09)
无470(73.44)191(86.65)279(66.91)
过去1年自付医疗费用[元，n(%)]1.9580.376
<1 000348(57.38)121(54.26)227(54.44)
1 000~2 999170(26.56)65(29.15)105(25.18)
≥3 000122(19.06)37(16.59)85(20.38)
), ArticleFig(id=1324077665543663958, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=表2, caption=

2022年杭州市富阳区不同人口学特征下居民低健康素养水平情况

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容总人群(n=640)高健康素养水平(n=223)低健康素养水平(n=417)Z/χ2值P值
年龄[岁，M(P25, P75)]51.00(41.00，58.75)43.00(34.00，51.00)55.00(48.00，61.00)-11.450<0.001
居住地[n(%)]35.846<0.001
城区160(25.00)87(39.01)73(17.51)
农村480(75.00)136(60.99)344(82.49)
户籍[n(%)]0.0100.921
本地612(95.63)213(95.52)399(95.68)
其他28(4.38)10(4.48)18(4.32)
性别[n(%)]0.0460.831
男312(48.75)110(49.33)202(48.44)
女328(51.25)113(50.67)215(51.56)
民族[n(%)]0.3040.179
汉族636(99.38)223(100.00)413(99.04)
其他4(0.63)0(0)4(0.96)
文化程度[n(%)]153.748<0.001
初中及以下380(59.38)59(26.46)321(76.98)
初中以上260(40.61)164(73.54)96(23.02)
婚姻情况[n(%)]13.2230.001
未婚61(9.53)34(15.25)27(6.47)
在婚523(81.72)169(75.78)354(84.89)
分居/离异/丧偶56(8.75)20(8.97)36(8.63)
职业[n(%)]108.280<0.001
公务员/教师/医务人员/其他事业单位人员74(11.56)51(22.87)23(5.52)
学生14(2.19)8(3.59)6(1.44)
农民/工人350(54.69)63(28.25)287(68.82)
其他企业人员143(22.34)77(34.53)66(15.83)
其他59(9.22)24(10.76)35(8.39)
家庭人均年收入[元，n(%)]68.826<0.001
<30 000331(51.72)65(29.15)266(63.79)
≥30 000309(48.28)158(70.85)151(36.21)
是否吸烟[n(%)]0.9790.322
是176(27.50)56(25.11)120(28.78)
否464(72.50)167(74.89)297(71.22)
是否接触二手烟[n(%)]0.7070.400
是350(54.69)127(56.95)223(53.48)
否290(45.31)96(43.05)194(46.52)
有无慢性病[n(%)]26.169<0.001
有170(26.56)32(14.35)138(33.09)
无470(73.44)191(86.65)279(66.91)
过去1年自付医疗费用[元，n(%)]1.9580.376
<1 000348(57.38)121(54.26)227(54.44)
1 000~2 999170(26.56)65(29.15)105(25.18)
≥3 000122(19.06)37(16.59)85(20.38)
), ArticleFig(id=1324077665623355735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of age groups and low health literacy

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
年龄（岁）
≤51岁1.0001.000
>51岁6.627(4.545~9.662)<0.0013.377(2.120~5.378)<0.001
), ArticleFig(id=1324077665715630424, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=表3, caption=

年龄与居民低健康素养水平关联的logistics回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
年龄（岁）
≤51岁1.0001.000
>51岁6.627(4.545~9.662)<0.0013.377(2.120~5.378)<0.001
), ArticleFig(id=1324077665824682329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=EN, label=Table 4, caption=

Additive interaction of age groups and educational level on low health literacy

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
年龄（岁）文化程度
≤51岁初中以上1.0001.000
≤51岁初中及以下5.626(3.447~9.182)<0.0014.459(2.486~7.998)<0.001
>51岁初中以上3.329(1.851~5.986)<0.0013.041(1.573~5.881)0.001
>51岁初中及以下24.666(14.474~42.032)<0.00116.479(8.373~32.434)<0.001
RERI16.711(4.599~28.823)9.979(0.389~19.569)
AP0.677(0.498~0.857)0.606(0.368~0.843)
SI3.403(1.857~6.237)2.814(1.442~5.492)
), ArticleFig(id=1324077665912762714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077660007182630, language=CN, label=表4, caption=

年龄、文化程度对居民低健康素养水平的相加交互作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
年龄（岁）文化程度
≤51岁初中以上1.0001.000
≤51岁初中及以下5.626(3.447~9.182)<0.0014.459(2.486~7.998)<0.001
>51岁初中以上3.329(1.851~5.986)<0.0013.041(1.573~5.881)0.001
>51岁初中及以下24.666(14.474~42.032)<0.00116.479(8.373~32.434)<0.001
RERI16.711(4.599~28.823)9.979(0.389~19.569)
AP0.677(0.498~0.857)0.606(0.368~0.843)
SI3.403(1.857~6.237)2.814(1.442~5.492)
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年龄对居民低健康素养水平的影响及交互作用分析
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赵薇 1, 2 , 黄丹妮 2 , 寿碧琪 2 , 姚杏娟 1
现代预防医学 | 基层卫生服务 2026,53(6): 1055-1061
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现代预防医学 |基层卫生服务 2026 , 53 (6) : 1055 -1061
年龄对居民低健康素养水平的影响及交互作用分析
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赵薇1, 2, 黄丹妮2, 寿碧琪2, 姚杏娟1
作者信息
  • 1.南京医科大学公共卫生学院，江苏 南京 211166
  • 2.杭州市富阳区疾病预防控制中心（杭州市富阳区卫生监督所）健康教育和慢性病管理科
通讯作者:
姚杏娟，E-mail:
作者简介:

赵薇（1997—），女，硕士在读，医师，研究方向：公共卫生

Analysis of factors associated with low health literacy among residents: the impact and interaction of age
Wei ZHAO1, 2, Dan-ni HUANG2, Bi-qi SHOU2, Xing-juan YAO1
Affiliations
  • School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202509503
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摘要
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目的

了解年龄对杭州市富阳区居民低健康素养水平的影响，并探究其与其他影响因素间的交互作用。

方法

采用分层多阶段随机抽样法抽取该区15~69周岁常住居民进行健康素养问卷调查，收集基本人口学信息和健康素养水平。采用限制性立方样条（RCS）模型和logistic回归模型分析年龄与居民低健康素养水平的关联，并进一步应用相乘、相加交互作用模型探索年龄与其他影响因素对居民低健康素养水平的联合作用。

结果

640名调查对象中，低健康素养水平居民417名（65.16%）。RCS曲线显示，调整混杂因素后，年龄和居民低健康素养水平呈非线性剂量-反应关系（Pnonlinear<0.01），确定拐点为51岁，并以此为界纳入多因素logistic回归中结果显示，年龄>51岁组（OR=3.377, 95% CI: 2.120~5.378）与居民低健康素养水平相关（P<0.05）。交互作用结果显示，年龄和文化程度存在相加交互作用（RERI=9.979, 95% CI: 0.389~19.569; AP=0.606, 95% CI: 0.368~0.843; SI=2.814, 95% CI: 1.442~5.492）。

结论

高龄（51岁）是居民低健康素养水平的重要影响因素，进一步交互作用分析提示高龄且低文化程度人群是健康素养工作关注和干预的重点对象。

年龄  /  健康素养  /  限制性立方样条  /  交互作用
Objective

To examine the impact of age on low health literacy level among residents in Fuyang District of Hangzhou, and to elucidate its interactive effect with other determinants.

Methods

A questionnaire survey was conducted among residents aged 15-69 years old by multi-stage stratified random sampling. Data on basic demographic characteristics and health literacy levels were collected. The associations were examined using the Mann-Whitney U test, Chi-square test, the restricted cubic splines (RCS) model, and multivariable-adjusted logistic regression models.Furthermore, multiplicative and additive interaction models were applied to explore the joint effects of age and other influencing factors on low health literacy.

Results

Among the 640 respondents, 417 (65.16%) had a low health literacy level. After adjusting for potential confounders, the RCS model revealed a significant nonlinear dose-response relationship between age and the risk of low health literacy (Pnonlinear<0.01), with an inflection point at 51 years old. Subsequently, multivariate logistic regression analysis using this cut-off value demonstrated that individuals aged over 51 years old had a significantly higher risk of low health literacy (OR=3.377, 95% CI: 2.120-5.378, P<0.05). Regarding interaction effects, an additive interaction was observed between age and educational level (RERI=9.979, 95% CI: 0.389-19.569; AP=0.606, 95% CI: 0.368-0.843; SI=2.814, 95% CI: 1.442-5.492).

Conclusion

Age is an independent influencing factor of low health literacy levels among residents. Further interaction analysis reveals that individuals with advanced age and low educational attainment are identified as the key target population for health literacy promotion and intervention efforts.

Age  /  Health literacy  /  The restricted cubic splines  /  Interaction
赵薇, 黄丹妮, 寿碧琪, 姚杏娟. 年龄对居民低健康素养水平的影响及交互作用分析. 现代预防医学, 2026 , 53 (6) : 1055 -1061 . DOI: 10.20043/j.cnki.MPM.202509503
Wei ZHAO, Dan-ni HUANG, Bi-qi SHOU, Xing-juan YAO. Analysis of factors associated with low health literacy among residents: the impact and interaction of age[J]. Modern Preventive Medicine, 2026 , 53 (6) : 1055 -1061 . DOI: 10.20043/j.cnki.MPM.202509503
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健康素养是指个人获取、理解、处理基本的健康信息和服务，并运用这些信息和服务作出适当的卫生健康决策，以维护和促进自身健康的能力[1]。低健康素养水平个体不仅更易出现不良健康行为[2-3]，还会增加医疗支出[4]，甚至与不良健康结局相关[2,5]，对个人和社会造成双重负担。既往研究表明，年龄是影响居民低健康素养水平的重要人口学因素[3,6-7]，明确年龄与居民低健康素养水平之间的真实关系，有助于识别高风险年龄人群，为制定与年龄相适应的健康素养促进策略提供依据，从而切实支持健康老龄化目标的实现[8]。然而既有研究多将年龄视为线性变量或采取主观分组方式进行分析[3,7,9]，假定居民低健康素养水平随年龄呈均匀或呈简单阶梯式变化，实际上多项研究表明个体在不同生命阶段的认知能力、学习模式等随年龄发生非线性演变[10-11]，因此居民低健康素养水平与年龄的关系很可能包含关键转折点与阶段性等非线性特征，而简单线性假设或主观分组难以揭示不同年龄间风险变化的动态规律和关键突变风险，导致健康干预措施与目标人群实际需求脱节。此外，年龄对居民低健康素养水平的影响并非孤立存在，往往与文化程度、收入、慢性病等社会人口学、健康相关因素耦合[12-15]，不同年龄与其他影响因素的组合可能导致居民低健康素养风险存在显著差异，但目前国内外关于此类交互作用的量化证据仍较为有限。为此本研究利用2022年杭州市富阳区居民健康素养监测调查数据，重点探讨年龄与居民低健康素养水平之间潜在的非线性关联，并进一步探索年龄与其他影响因素对居民低健康素养水平的修饰作用，从而为制定针对生命历程视角下精准化居民低健康素养水平提升策略提供科学依据。
1　对象和方法
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1.1　调查对象
以2022年杭州市富阳区15~69周岁常住居民为调查对象。
纳入标准：（1）过去一年内在杭州市富阳区日常居住的时间≥6个月；（2）同意参与，并充分了解研究目的、内容和流程，自愿签署知情同意书。
排除标准：（1）存在严重语言沟通困难、意识或认知状态异常者；（2）长期居住集体地点的，如军事基地、医院、监狱、养老院、宿舍等；（3）非中国籍居民。
本研究通过浙江省疾病预防控制中心伦理委员会批准（审批号：2022-027-01），所有调查对象均知情同意。
1.2　方法
1.2.1　抽样方法
采用分层多阶段、与人口规模成比例的整群抽样方法（probability proportionate to size sampling, PPS）、随机抽样相结合的方法完成抽样。第一阶段：采用PPS法抽取4个街道（乡镇）；第二阶段：采用PPS法在已抽取的街道（乡镇）中各抽取2个社区（村）；第三阶段：采用随机抽样法在已抽取的社区（村）中抽取100个家庭户。第四阶段：采用Kish Grid法抽取1名符合条件的调查对象，每个社区（村）完成80份问卷为止。
1.2.2　调查方法
采用国家统一的《全国居民健康素养监测调查问卷》[7]，由经过统一培训的调查员入户调查。问卷内容主要包括基本人口学信息、健康素养内容等。其中健康素养的问卷题型包含判断题、单选题和多选题，计分方法和判断标准严格按照国家统一评分标准。若总体答题得分<总分的80%，即总分53分以下，则判定该居民为低健康素养水平[9]。具体变量赋值详见表1。
1.3　统计分析
使用SPSS 26.0和R 4.4.2软件进行统计分析。计量资料采用M(P25, P75)表示，计数资料采用频数（比例）表示，采用Mann-Whitney U检验和χ2检验比较组间差异。采用限制性立方样条（restricted cubic spline, RCS）模型探究年龄与居民低健康素养水平之间的剂量-反应关系。采用logistics回归分析年龄与居民低健康素养水平之间的相关性，并进一步应用相乘和相加交互作用模型探索年龄与其他影响因素对居民低健康素养水平的联合作用。相加交互评价指标包括相对超额危险度（relative excess risk due to interaction, RERI）、归因比（attributable proportion due to interaction, AP）、交互作用指数（the synergy index, SI）及相应95%置信区间（confidence interal, CI），如果RERI及AP的95% CI不包含0且SI的95% CI不包含1，表明两因素之间存在相加交互作用。检验水准α=0.05。
2　结果
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2.1　调查对象的基本特征
2022年有效调查640人，中位年龄为51.00岁。其中低健康素养水平组417名（65.16%），其中位年龄显著高于高健康素养水平组（P<0.05）。此外，两组在居住地、文化程度、婚姻情况、职业、家庭人均年收入和有无慢性病方面的差异均具有统计学意义（P<0.05），详见表2。
2.2　年龄与居民低健康素养水平的剂量-反应关系
为量化年龄和居民低健康素养水平之间的非线性关系，采用限制性立方样条模型（设置节点数为3个）进行分析，结果显示，调整相关混杂因素后，年龄与居民低健康素养水平风险呈非线性相关（Pnonlinear=0.004 3）。当年龄小于51岁时OR小于1，对居民低健康素养水平发生风险起到保护作用；当年龄>51岁，OR>1，说明年龄超过51岁居民低健康素养水平发生风险逐渐加大。详见图1。
2.3　居民低健康素养水平的logistics回归分析
以是否为低健康素养（是=1；否=0）为因变量，根据调整后RCS曲线拐点51岁为界，将年龄分为两组，即年龄≤51岁组和年龄>51岁组，纳入非条件logistic回归模型分析。调整相关混杂因素后结果显示，年龄>51岁组（OR=3.377, 95% CI: 2.120~5.378）与居民低健康素养水平风险呈正相关（P<0.05）。详见表3。
2.4　居民低健康素养水平的亚组分析
根据logistic回归分析结果，基于居住地、文化程度、家庭人均年收入和有无慢性病进行亚组分析，除各亚组的因素外，调整了户籍、性别、民族、婚姻情况、职业、是否吸烟、是否接触二手烟、过去1年自付医疗费用，结果显示在各亚组中年龄仍与居民低健康素养水平风险显著正相关（P<0.05）。详见图2。
2.5　年龄对居民低健康素养水平的交互作用
以是否为低健康素养（是=1；否=0）为因变量，调整相关混杂因素后，相乘交互作用结果表明年龄与居住地、文化程度、家庭人均年收入和有无慢性病对居民低健康素养水平均不存在相乘交互作用（P>0.05），详见图2。相加交互作用结果显示，同时存在年龄>51岁和文化程度初中及以下的居民低健康素养水平的风险较大（OR=16.479, 95% CI: 8.373~32.434），两者同时存在时低健康素养水平风险是两者单独存在风险之和的2.814倍（RERI=9.979, 95% CI: 0.389~19.569; AP=0.606, 95% CI: 0.368~0.843），且60.6%的低健康素养水平风险归因于两者的联合作用（SI=2.814, 95% CI: 1.442~5.492），详见表4。未发现年龄与居住地、家庭人均年收入和有无慢性病的相加交互作用。
3　讨论
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本研究中杭州市富阳区居民低健康素养水平为[CM（83.4mm]65.16%，虽然低于全国水平[7]，但仍高于浙江省水平[17]，表明该区居民低健康素养水平现状普遍存在，相关部门仍需加强提升干预工作，持续推进健康中国行动，大力开展健康知识普及行动。
本研究通过RCS模型量化了年龄与居民低健康素养水平之间的非线性剂量-反应关系，并将风险拐点锚定于51岁，揭示居民低健康素养水平随年龄的增长并非匀速恶化，而是在生命历程的特定阶段出现风险的急剧跃升，与相似研究结论一致[10]。51岁以上人群多处于中年向老年过渡阶段，往往伴随身体机能下降、慢性病高发及社会角色等一系列生理和社会角色的转变[18-19]。这提示公共卫生干预不能仅聚焦于传统意义上的“老年人”，而应将“中年晚期”至“老年早期”这一过渡群体列为关键干预的时间窗口，实施前瞻性的健康素养提升工作，是实现积极老龄化的重要策略[8,20]。
根据RCS拐点将研究对象分为两组（≤51岁组和>51岁组）纳入logistic回归分析中，结果显示年龄与居民低健康素养水平风险呈正相关，与以往研究一致[21-22]。亚组分析结果显示，年龄对居民低健康素养水平的影响在不同居住地、文化程度、家庭人均收入和有无慢性病的人群中稳定存在，印证了其关联具有普遍性和稳健性[6-7,13]。此外，本研究尚未观察到年龄与各亚组对居民低健康素养水平的相乘交互作用，提示在相对危险度层面，以上影响因素未能显著改变年龄对居民低健康素养水平影响的相对效应，与以往研究有所不同[12,15]，可能与本研究调查人群特征或样本量限制下检验效能不足有关。
更具公共卫生意义的是，本研究发现了年龄与文化程度之间存在显著的相加交互作用。在调整可能混杂因素后，“高龄”和“低文化程度”两者同时存在时低健康素养水平风险大于两者单独效应之和，呈现“1+1>2”的叠加效应。这一发现在另一研究的人群分布上得到进一步印证：通过多重对应分析发现，“高龄+低文化程度”人群在低健康素养类别中高度聚集，共同揭示了在绝对风险层面年龄和文化双重劣势的累积效应[13]。对于出生于上世纪70年代以前的群体，普遍接受的正规教育年限较短[23]，其基础阅读理解和批判性思维能力有限，当步入中老年后，本身可能因认知功能自然衰退、信息获取渠道受限及许多观念和行为习惯根深蒂固，面临低健康素养水平的风险，而早年因低文化程度导致的认知局限，更会限制个体理解复杂健康信息及进行有效自我健康管理，两种劣势相互叠加，放大了对于健康信息的获取、理解和应用上的劣势，加剧了健康素养的不平等。因此健康教育政策制定应具备生命历程视角和精准干预思维：一方面因年龄为不可逆转的生命历程变量，强化生命早期教育是治本之策，不仅要在学校教育阶段夯实健康知识的基础，更要在成年后，如职业初期、孕产期等关键节点提供持续性的健康教育，构建覆盖“全生命周期”的健康教育体系；另一方面推动分群体、分层次的精准化干预，将高龄低文化程度人群作为健康教育优先关注的核心人群，深入剖析切实需求和现实困难，设计针对性“低门槛”的健康传播工具和路径，如图文并茂的手册、可视化材料、“代际+社群”教育[24-25]等，从而破解健康素养的“洼地”效应，推动健康公平和健康老龄化。
本研究引入RCS模型灵活探索了年龄与居民低健康素养水平的非线性关系，并确定了关键年龄节点，同时通过交互作用量化年龄与文化程度的协同效应，为识别更为脆弱的高危人群提供依据，有助于提升公共卫生资源投放的效率和效果。但本研究作为横断面研究，无法进行因果推断，其次样本数量有限且来源于同一地区，外推性需谨慎。未来研究可开展多中心纵向调查，进一步验证年龄与健康素养的因果路径，并探索其他可能存在的交互作用。

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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202509503
  • 接收时间：2025-09-29
  • 首发时间：2026-11-02
  • 出版时间：2026-03-25
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  • 收稿日期：2025-09-29
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    1.南京医科大学公共卫生学院，江苏 南京 211166
    2.杭州市富阳区疾病预防控制中心（杭州市富阳区卫生监督所）健康教育和慢性病管理科

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姚杏娟，E-mail:
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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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