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Article(id=1324077670291604058, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077560820282023, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509357, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758470400000, receivedDateStr=2025-09-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614316771, onlineDateStr=2026-11-02, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614316771, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614316771, creator=13701087609, updateTime=1793614316771, 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=1089, endPage=1093, ext={EN=ArticleExt(id=1324077670522290779, articleId=1324077670291604058, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Longitudinal association between social isolation and frailty in Chinese middle-aged and older adults, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between social isolation and frailty trajectories, and to provide evidence for targeted interventions and healthy aging.

Methods

Based on four waves (2011-2018) of the China Health and Retirement Longitudinal Study, 7 805 adults aged 45 years and above were included. Latent Class Mixed Models (LCMM) wereapplied to identify longitudinal trajectories of social isolation and the frailty index.Multinomial logistic regression was used to analyze factors associated with each trajectory, and conditional and joint probabilities were calculated to evaluate the correspondence between social isolation and frailty trajectories.

Results

Four trajectories of social isolation were identified: Low-isolation stable (36.0%), Low-isolation rapid increase (2.7%), Moderate-isolation stable(52.7%), andHigh-isolation slow increase(8.7%)—along with three frailty trajectories: Robust stable(27.0%), Prefrail stable (54.2%), and Frailty worsening (18.8%).Joint probabilities further indicated that the combination of Moderate-isolation stable and Prefrail-stable had the highest overall probability (πjk=0.29).

Conclusion

Levels and temporal patterns of social isolation are strongly associated with frailty development. Middle-aged and older adults with higher or increasing isolation levels, as well as those at the prefrail stage, should be prioritized in community-based interventions aimed at strengthening social support, maintaining physical function, and improving psychological well-being to delay frailty progression and promote healthy aging.

, authors=Yu JIANG, Chen-yue JIANG, Na CHEN, authorsList=Yu JIANG, Chen-yue JIANG, Na CHEN, authorCompany=null, correspAuthors=Na CHEN, 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=1324077671843496550, articleId=1324077670291604058, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国中老年人社会隔离与衰弱的纵向关联研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨社会隔离与衰弱轨迹的关系，为精准干预和健康老龄化提供参考。

方法

基于2011—2018年中国健康与养老追踪调查（CHARLS）四期数据，纳入7 805名中老年人，采用潜在类别混合模型（LCMM）识别社会隔离与衰弱指数（FI）的纵向轨迹，运用多项logistic回归分析各轨迹的影响因素，并计算社会隔离与衰弱轨迹的条件概率和联合概率。

结果

共识别出社会隔离的四条轨迹——“低隔离稳定组”（36.0%）、“低隔离急升组”（2.7%）、“中度隔离稳定组”（52.7%）和“高隔离缓升组”（8.7%）；以及衰弱的三条轨迹——“健康稳定组”（27.0%）、“衰弱前期稳定组”（54.2%）和“衰弱加重组”（18.8%）。双轨迹分析显示，“中度隔离稳定组”与 “衰弱前期稳定组”的联合概率最高（πjk=0.29）。

结论

社会隔离的水平及其变化趋势与衰弱的发展轨迹存在显著关联。针对隔离水平较高或呈上升趋势的群体，以及处于衰弱前期阶段的中老年人，需在社区中加强社会支持、功能维护与心理健康管理，以延缓衰弱进展并促进健康老龄化。

, authors=蒋煜, 蒋晨悦, 陈娜, authorsList=蒋煜, 蒋晨悦, 陈娜, authorCompany=null, correspAuthors=陈娜, authorNote=

蒋煜（2001—），女，硕士在读，研究方向：公共管理

, correspAuthorsNote=
陈娜，E-mail:
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蒋煜（2001—），女，硕士在读，研究方向：公共管理

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蒋煜（2001—），女，硕士在读，研究方向：公共管理

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(In Chinese), articleTitle=The association between social isolation, loneliness and smoking behavior among the elderly adults in China, refAbstract=null)], funds=[Fund(id=1324077678256587413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, awardId=ZT202202, language=CN, fundingSource=江苏省中医药科技发展计划专题研究项目(ZT202202), fundOrder=null, country=null), Fund(id=1324077678361445014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, awardId=null, language=CN, fundingSource=江苏高校“青蓝工程”, fundOrder=null, country=null), Fund(id=1324077678462108311, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, awardId=B-b/2024/01/107, language=CN, fundingSource=江苏省教育科学规划课题（重点项目）(B-b/2024/01/107), fundOrder=null, country=null), Fund(id=1324077678562771608, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, awardId=2024YLFWYGL016, language=CN, fundingSource=南京中医药大学养老服务与管理学院（养老产业学院）专项研究项目(2024YLFWYGL016), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077672086766183, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, xref=null, ext=[AuthorCompanyExt(id=1324077672099349096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, companyId=1324077672086766183, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1324077672107737705, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, companyId=1324077672086766183, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南京中医药大学养老服务与管理学院，江苏 南京 210023)])], figs=[ArticleFig(id=1324077673990980225, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Fig.1, caption=Social isolation trajectory, figureFileSmall=PB7buIGE6p4kSa7eIbDx5A==, figureFileBig=+nLxHpJj6qxtOlxRgeAFaQ==, tableContent=null), ArticleFig(id=1324077674053894786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=图1, caption=社会隔离轨迹, figureFileSmall=PB7buIGE6p4kSa7eIbDx5A==, figureFileBig=+nLxHpJj6qxtOlxRgeAFaQ==, tableContent=null), ArticleFig(id=1324077674364273283, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Fig.2, caption=Frailty trajectory, figureFileSmall=/KFZ+Qu+Vn8xYpqldLxNyQ==, figureFileBig=LHi1aDnMjAD5v7r889Nn7Q==, tableContent=null), ArticleFig(id=1324077674448159364, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=图2, caption=衰弱轨迹, figureFileSmall=/KFZ+Qu+Vn8xYpqldLxNyQ==, figureFileBig=LHi1aDnMjAD5v7r889Nn7Q==, tableContent=null), ArticleFig(id=1324077674527851141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 1, caption=

Baseline characteristics of participants by social isolation trajectory group

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体低隔离稳定低隔离急升中度隔离稳定高隔离缓升P
人数7 8052 8062084 114677
年龄（岁）57.24±8.2055.80±7.7360.68±8.8857.10±7.8863.06±8.93<0.001
女性4 069 (52.1)1 385(49.4)132(63.5)2 154(52.4)398(58.8)<0.001
居住地（农村）4 671(59.8)1 488(53.0)126(60.6)2 635(64.0)422(62.3)<0.001
教育
初中及以下6 707 (85.9)2 252(80.3)180 (86.5)3 649(88.7)626(92.5)<0.001
高中和职业培训958(12.3)467(16.6)21(10.1)423(10.3)47(6.9)
高等教育140(1.8)87(3.1)7(3.4)42(1.0)4(0.6)
现在吸烟2 277(29.2)886(31.6)52(25.0)1 151(28.0)188(27.8)0.004
现在饮酒2 617(33.5)1 044 (37.2)55(26.4)1 325(32.2)193(28.5)<0.001
), ArticleFig(id=1324077674804675206, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表1, caption=

社会隔离轨迹组的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体低隔离稳定低隔离急升中度隔离稳定高隔离缓升P
人数7 8052 8062084 114677
年龄（岁）57.24±8.2055.80±7.7360.68±8.8857.10±7.8863.06±8.93<0.001
女性4 069 (52.1)1 385(49.4)132(63.5)2 154(52.4)398(58.8)<0.001
居住地（农村）4 671(59.8)1 488(53.0)126(60.6)2 635(64.0)422(62.3)<0.001
教育
初中及以下6 707 (85.9)2 252(80.3)180 (86.5)3 649(88.7)626(92.5)<0.001
高中和职业培训958(12.3)467(16.6)21(10.1)423(10.3)47(6.9)
高等教育140(1.8)87(3.1)7(3.4)42(1.0)4(0.6)
现在吸烟2 277(29.2)886(31.6)52(25.0)1 151(28.0)188(27.8)0.004
现在饮酒2 617(33.5)1 044 (37.2)55(26.4)1 325(32.2)193(28.5)<0.001
), ArticleFig(id=1324077675287020167, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 2, caption=

Baseline characteristics of participants by frailty trajectory group

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体健康稳定组衰弱前期稳定组衰弱加重组P
人数7 8052 1104 2281 467
年龄（岁）57.24±8.2055.80±7.7357.10±7.8863.06±8.93<0.001
女性4 069 (52.1)1 385(49.4)2 154(52.4)398(58.8)<0.001
居住地（农村）4 671(59.8)1 164(55.2)2 542(60.1)965(65.8)<0.001
教育
初中及以下6 707 (85.9)1 653(78.3)3 684(87.1)1 370(93.4)<0.001
高中和职业培训958(12.3)394(18.7)478(11.3)86(5.9)
高等教育140(1.8)63(3.0)66(1.6)11(0.7)
现在吸烟2 277(29.2)690(32.7)1 295(30.6)292(19.9)0.004
现在饮酒2 617(33.5)853(40.4)1 431(33.8)333(22.7)<0.001
), ArticleFig(id=1324077676041994888, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表2, caption=

衰弱轨迹组的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总体健康稳定组衰弱前期稳定组衰弱加重组P
人数7 8052 1104 2281 467
年龄（岁）57.24±8.2055.80±7.7357.10±7.8863.06±8.93<0.001
女性4 069 (52.1)1 385(49.4)2 154(52.4)398(58.8)<0.001
居住地（农村）4 671(59.8)1 164(55.2)2 542(60.1)965(65.8)<0.001
教育
初中及以下6 707 (85.9)1 653(78.3)3 684(87.1)1 370(93.4)<0.001
高中和职业培训958(12.3)394(18.7)478(11.3)86(5.9)
高等教育140(1.8)63(3.0)66(1.6)11(0.7)
现在吸烟2 277(29.2)690(32.7)1 295(30.6)292(19.9)0.004
现在饮酒2 617(33.5)853(40.4)1 431(33.8)333(22.7)<0.001
), ArticleFig(id=1324077676155241098, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 3, caption=

Multinomial logistic regression for predictors of social isolation trajectories

, figureFileSmall=null, figureFileBig=null, tableContent=
变量低隔离急升组中度隔离稳定组高隔离缓升组
OR (95%CI)POR (95%CI)POR (95%CI)P
年龄1.08(1.06~1.10)<0.0011.02(1.02~1.03)<0.0011.12(1.10~1.13)<0.001
性别（参照：女性）
男性0.46(0.31~0.69)<0.0011.02(0.89~1.16)0.7930.53(0.42~0.67)<0.001
居住地（参照：农村）
城市1.53(1.13~2.07)0.0061.02(0.89~1.16)0.7931.56(1.30~1.87)<0.001
教育程度（参照：初中及以下）
高中和职业培训0.91(0.56~1.46)0.6850.66(0.57~0.76)<0.0010.63(0.46~0.88)0.006
高等教育1.19(0.53~2.72)0.6730.36(0.24~0.52)<0.0010.16(0.06~0.46)<0.001
吸烟 （参照：否）
是1.16(0.78~1.74)0.4670.85(0.74~0.96)0.0121.20(0.95~1.53)0.127
饮酒（参照：否）
是0.87(0.61~1.25)0.4570.87(0.77~0.98)0.0180.94(0.75~1.16)0.550
), ArticleFig(id=1324077676490785419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表3, caption=

社会隔离轨迹影响因素的多项logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量低隔离急升组中度隔离稳定组高隔离缓升组
OR (95%CI)POR (95%CI)POR (95%CI)P
年龄1.08(1.06~1.10)<0.0011.02(1.02~1.03)<0.0011.12(1.10~1.13)<0.001
性别（参照：女性）
男性0.46(0.31~0.69)<0.0011.02(0.89~1.16)0.7930.53(0.42~0.67)<0.001
居住地（参照：农村）
城市1.53(1.13~2.07)0.0061.02(0.89~1.16)0.7931.56(1.30~1.87)<0.001
教育程度（参照：初中及以下）
高中和职业培训0.91(0.56~1.46)0.6850.66(0.57~0.76)<0.0010.63(0.46~0.88)0.006
高等教育1.19(0.53~2.72)0.6730.36(0.24~0.52)<0.0010.16(0.06~0.46)<0.001
吸烟 （参照：否）
是1.16(0.78~1.74)0.4670.85(0.74~0.96)0.0121.20(0.95~1.53)0.127
饮酒（参照：否）
是0.87(0.61~1.25)0.4570.87(0.77~0.98)0.0180.94(0.75~1.16)0.550
), ArticleFig(id=1324077676910215820, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 4, caption=

Multinomial logistic regression for predictors of frailty trajectories

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变量衰弱前期稳定组衰弱加重组
OR(95%CI)POR(95%CI)P
年龄1.05 (1.04~1.06)<0.0011.10 (1.09~1.11)<0.001
性别（参照：女性）
男性0.64 (0.55~0.74)<0.0010.35 (0.29~0.42)<0.001
居住地（参照：农村）
城市1.21 (1.08~1.35)<0.0011.64 (1.41~1.91)<0.001
教育程度（参照：初中及以下）
高中和职业培训0.68 (0.58~0.79)<0.0010.46 (0.35~0.59)<0.001
高等教育0.53 (0.37~0.76)0.0010.27 (0.14~0.53)<0.001
吸烟 （参照：否）
是1.18 (1.03~1.36)0.0190.99 (0.81~1.21)0.936
饮酒（参照：否）
是0.91 (0.81~1.04)0.1620.76 (0.63~0.90)0.002
), ArticleFig(id=1324077676985713293, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表4, caption=

衰弱轨迹影响因素的多项logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量衰弱前期稳定组衰弱加重组
OR(95%CI)POR(95%CI)P
年龄1.05 (1.04~1.06)<0.0011.10 (1.09~1.11)<0.001
性别（参照：女性）
男性0.64 (0.55~0.74)<0.0010.35 (0.29~0.42)<0.001
居住地（参照：农村）
城市1.21 (1.08~1.35)<0.0011.64 (1.41~1.91)<0.001
教育程度（参照：初中及以下）
高中和职业培训0.68 (0.58~0.79)<0.0010.46 (0.35~0.59)<0.001
高等教育0.53 (0.37~0.76)0.0010.27 (0.14~0.53)<0.001
吸烟 （参照：否）
是1.18 (1.03~1.36)0.0190.99 (0.81~1.21)0.936
饮酒（参照：否）
是0.91 (0.81~1.04)0.1620.76 (0.63~0.90)0.002
), ArticleFig(id=1324077677304480398, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 5, caption=

Conditional probability of FI trajectory given SI trajectory (πk｜j)

, figureFileSmall=null, figureFileBig=null, tableContent=
衰弱轨迹组社会隔离轨迹组
低隔离稳定组低隔离急升组中度隔离稳定组高隔离缓升组
健康稳定组0.320.210.250.19
衰弱前期稳定组0.540.530.550.51
衰弱加重组0.140.260.200.30
), ArticleFig(id=1324077677400949391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表5, caption=

在不同社会隔离轨迹下衰弱轨迹的条件概率(πk｜j)

, figureFileSmall=null, figureFileBig=null, tableContent=
衰弱轨迹组社会隔离轨迹组
低隔离稳定组低隔离急升组中度隔离稳定组高隔离缓升组
健康稳定组0.320.210.250.19
衰弱前期稳定组0.540.530.550.51
衰弱加重组0.140.260.200.30
), ArticleFig(id=1324077677463863952, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 6, caption=

Conditional probability of SI trajectory given FI trajectory (πj｜k)

, figureFileSmall=null, figureFileBig=null, tableContent=
社会隔离轨迹组衰弱轨迹组
健康稳定组衰弱前期稳定组衰弱加重组
低隔离稳定组0.430.360.27
低隔离急升组0.020.030.04
中度隔离稳定组0.490.540.56
高隔离缓升组0.060.080.14
), ArticleFig(id=1324077677564527250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表6, caption=

在不同衰弱轨迹下社会隔离轨迹的条件概率(πj｜k)

, figureFileSmall=null, figureFileBig=null, tableContent=
社会隔离轨迹组衰弱轨迹组
健康稳定组衰弱前期稳定组衰弱加重组
低隔离稳定组0.430.360.27
低隔离急升组0.020.030.04
中度隔离稳定组0.490.540.56
高隔离缓升组0.060.080.14
), ArticleFig(id=1324077677765853843, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=EN, label=Table 7, caption=

Joint probability distribution of FI and SI trajectories(πjk)

, figureFileSmall=null, figureFileBig=null, tableContent=
社会隔离轨迹组衰弱轨迹组
健康稳定组衰弱前期稳定组衰弱加重组
低隔离稳定组0.120.190.05
低隔离急升组0.010.010.01
中度隔离稳定组0.130.290.10
高隔离缓升组0.020.040.03
), ArticleFig(id=1324077677858128532, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077670291604058, language=CN, label=表7, caption=

社会隔离与衰弱轨迹的联合概率分布(πjk)

, figureFileSmall=null, figureFileBig=null, tableContent=
社会隔离轨迹组衰弱轨迹组
健康稳定组衰弱前期稳定组衰弱加重组
低隔离稳定组0.120.190.05
低隔离急升组0.010.010.01
中度隔离稳定组0.130.290.10
高隔离缓升组0.020.040.03
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中国中老年人社会隔离与衰弱的纵向关联研究
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蒋煜 , 蒋晨悦 , 陈娜
现代预防医学 | 健康与社会行为 2026,53(6): 1089-1093
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现代预防医学 |健康与社会行为 2026 , 53 (6) : 1089 -1093
中国中老年人社会隔离与衰弱的纵向关联研究
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蒋煜（2001—），女，硕士在读，研究方向：公共管理

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蒋煜, 蒋晨悦, 陈娜
作者信息
  • 南京中医药大学养老服务与管理学院，江苏 南京 210023
通讯作者:
陈娜，E-mail:
作者简介:

蒋煜（2001—），女，硕士在读，研究方向：公共管理

Longitudinal association between social isolation and frailty in Chinese middle-aged and older adults
Yu JIANG, Chen-yue JIANG, Na CHEN
Affiliations
  • School of Public Health and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202509357
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摘要
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目的

探讨社会隔离与衰弱轨迹的关系，为精准干预和健康老龄化提供参考。

方法

基于2011—2018年中国健康与养老追踪调查（CHARLS）四期数据，纳入7 805名中老年人，采用潜在类别混合模型（LCMM）识别社会隔离与衰弱指数（FI）的纵向轨迹，运用多项logistic回归分析各轨迹的影响因素，并计算社会隔离与衰弱轨迹的条件概率和联合概率。

结果

共识别出社会隔离的四条轨迹——“低隔离稳定组”（36.0%）、“低隔离急升组”（2.7%）、“中度隔离稳定组”（52.7%）和“高隔离缓升组”（8.7%）；以及衰弱的三条轨迹——“健康稳定组”（27.0%）、“衰弱前期稳定组”（54.2%）和“衰弱加重组”（18.8%）。双轨迹分析显示，“中度隔离稳定组”与 “衰弱前期稳定组”的联合概率最高（πjk=0.29）。

结论

社会隔离的水平及其变化趋势与衰弱的发展轨迹存在显著关联。针对隔离水平较高或呈上升趋势的群体，以及处于衰弱前期阶段的中老年人，需在社区中加强社会支持、功能维护与心理健康管理，以延缓衰弱进展并促进健康老龄化。

社会隔离  /  衰弱  /  中老年人  /  潜在类别混合模型
Objective

To explore the relationship between social isolation and frailty trajectories, and to provide evidence for targeted interventions and healthy aging.

Methods

Based on four waves (2011-2018) of the China Health and Retirement Longitudinal Study, 7 805 adults aged 45 years and above were included. Latent Class Mixed Models (LCMM) wereapplied to identify longitudinal trajectories of social isolation and the frailty index.Multinomial logistic regression was used to analyze factors associated with each trajectory, and conditional and joint probabilities were calculated to evaluate the correspondence between social isolation and frailty trajectories.

Results

Four trajectories of social isolation were identified: Low-isolation stable (36.0%), Low-isolation rapid increase (2.7%), Moderate-isolation stable(52.7%), andHigh-isolation slow increase(8.7%)—along with three frailty trajectories: Robust stable(27.0%), Prefrail stable (54.2%), and Frailty worsening (18.8%).Joint probabilities further indicated that the combination of Moderate-isolation stable and Prefrail-stable had the highest overall probability (πjk=0.29).

Conclusion

Levels and temporal patterns of social isolation are strongly associated with frailty development. Middle-aged and older adults with higher or increasing isolation levels, as well as those at the prefrail stage, should be prioritized in community-based interventions aimed at strengthening social support, maintaining physical function, and improving psychological well-being to delay frailty progression and promote healthy aging.

Social isolation  /  Frailty  /  Middle-aged and older adults  /  Latent class mixed model
蒋煜, 蒋晨悦, 陈娜. 中国中老年人社会隔离与衰弱的纵向关联研究. 现代预防医学, 2026 , 53 (6) : 1089 -1093 . DOI: 10.20043/j.cnki.MPM.202509357
Yu JIANG, Chen-yue JIANG, Na CHEN. Longitudinal association between social isolation and frailty in Chinese middle-aged and older adults[J]. Modern Preventive Medicine, 2026 , 53 (6) : 1089 -1093 . DOI: 10.20043/j.cnki.MPM.202509357
正文
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随着人口老龄化加速，社会隔离与衰弱已成为影响老年人健康与功能独立的两大关键风险因素。社会隔离反映个体社会联系和社会支持系统的弱化，衰弱则体现机体生理储备及功能适应能力的下降，二者均与不良结局密切相关[1-2]。社会隔离可通过减少社会参与、削弱支持网络及增加抑郁和孤独感等心理社会途径，加速衰弱进程，并进一步导致身体功能受限和健康相关生命质量下降[3-5]。反之，衰弱的发生亦会限制老年人的社交能力与活动范围，增加其社会隔离风险[6]。社会隔离与衰弱之间可能存在相互作用，但既有研究多局限于阶段性或单向分析，尚未从时间维度揭示二者的动态演化规律。基于此，本研究利用2011—2018年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）纵向数据，采用潜在类别混合模型（Latent Class Mixed Model, LCMM）识别中老年人社会隔离与衰弱的发展轨迹，并通过条件概率与联合概率分析二者的交互演变规律，旨在揭示社会隔离与衰弱的双轨迹共演机制，为高风险人群的早期识别与干预提供实证依据。
1　资料与方法
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1.1　数据来源与研究对象
本研究采用2011—2018年中国健康与养老追踪调查四期数据，CHARLS为全国代表性调查，采用多阶段分层抽样方法，涵盖我国中老年人的健康状况、社会经济水平及家庭特征。本文选取的研究对象为45岁及以上的中老年人，剔除了社会隔离、衰弱指数或关键协变量缺失的个体。为保证轨迹模型的纵向稳定性，仅保留基线数据完整且至少参与两次及以上的样本，最终纳入7 805人。
1.2　主要变量与判定标准
1.2.1　社会隔离
本研究采用社会隔离指数对社会隔离程度进行衡量，该指标已在既往研究中得到验证并广泛应用[7-8]。测量内容包括婚姻状况、居住状况、与子女联系频率和社会活动参与4个条目，每项采用二元赋值，总分范围为0-4分，得分越高表示社会隔离程度越高[9]。
1.2.2　衰弱指数
本研究基于累积健康缺损模型构建衰弱指数（Frailty Index, FI），衡量个体的健康缺损水平[10-11]。计算公式为：FI=各健康缺损项目得分之和/指标总数。选取CHARLS问卷中30项健康状况指标，涵盖慢性疾病（如高血压、糖尿病、心脏病等）、日常生活活动（ADL/IADL）、感官功能（视力、听力、自评健康）、身体机能（行走1公里、提举重物、弯腰或下蹲、抬臂或伸手等）及认知功能（认知功能得分）等。其中，视力、听力和自评健康按等级赋值（由好到差依次为1、0.75、0.5、0.25、0），慢性病及功能受限条目按是否缺损二元赋值（1=无缺损，0=有缺损），认知功能按标准化得分处理。最终将各项目得分求平均，FI取值范围为0-1，分值越高表示衰弱程度越重。依据既往研究常用阈值标准，将 FI ≤ 0.10 定义为健康状态，0.10<FI<0.25 定义为衰弱前期，FI ≥ 0.25 定义为衰弱[12]。
1.2.3　协变量
根据以往的参考文献[13-14]，协变量包括年龄（连续）、性别（男性/女性）、居住地（城市/农村）、教育程度（初中及以下/高中和职业培训/高等教育）、现在吸烟情况（是/否）、现在饮酒情况（是/否）。
1.3　统计学方法
首先，对研究对象的人口学及生活方式特征进行描述性分析，计数资料以频数和百分比〔n（%）〕表示，计量资料以均数和标准差（）表示。组间差异采用t检验或方差分析（ANOVA），分类变量采用卡方检验或Fisher精确检验。其次，采用潜在类别混合模型（Latent Class Mixed Model，LCMM）识别社会隔离和衰弱指数的纵向轨迹[15]。通过比较不同类别数（2～5类）模型的拟合指标，包括Akaike信息准则（AIC）、贝叶斯信息准则（BIC）、平均后验概率（Ave-pp）和正确分类比值（OCC），确定最优轨迹组数[16-18]。在此基础上，分别以社会隔离和衰弱轨迹组为因变量，人口学及健康特征为自变量，构建多项logistic回归模型，结果以比值比（OR）及95%置信区间（CI）表示。最后，为探讨社会隔离轨迹与衰弱轨迹的关系，先采用卡方检验比较分布差异，再计算社会隔离与衰弱轨迹的条件概率和联合概率。所有数据分析均使用Stata 17.0和R 4.5.1软件。采用双侧检验，检验水准为α=0.05。
2　结果
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2.1　社会隔离轨迹组
随着类别数增加，AIC和BIC值均呈下降趋势。四类别模型（AIC=50 556.50，BIC=50 681.83）与五类别模型（AIC=50 382.59，BIC=50 535.77）均优于三类别模型，但五类别模型中两个样本量比例过小（1.4%和2.4%），在可解释性和稳定性方面均存在不足。综合考虑模型拟合度与类别可解释性，最终确定四类别模型为最优方案。图1展示了社会隔离的四条不同轨迹，分别为：“低隔离稳定组”（36%）、“低隔离急升组”（2.7%）、“中度隔离组稳定组”（52.7%）、和“高隔离缓升组”（8.7%）。
2.2　衰弱指数轨迹组
通过潜在类别增长模型对衰弱指数轨迹进行拟合，并比较 2-5 类模型的统计表现。结果显示，尽管四类和五类模型的 AIC 与 BIC 值略低，但其平均后验概率分别仅为 0.78 和 0.75，分类准确性和稳定性均不理想，且类别解释性有限。相比之下，三类模型的分类质量较高（Ave-PP=0.90，OCC=26.41），综合各项指标优于其他模型，因此最终选择三类模型作为最优解。确定的三条轨迹分别为：“健康稳定组”（27.0%）、“衰弱前期稳定组”（54.2%）和“衰弱加重组”（18.8%）。其轨迹模式如图2所示。
2.3　研究人群基线特征
表1和表2显示，社会隔离与衰弱轨迹组间在人口学及生活方式特征上差异显著（P<0.01）。总体样本平均年龄为（57.24±8.20）岁，女性占52.1%，农村居住者占59.8%。社会隔离轨迹中，样本主要分布于“低隔离稳定组”和“中度隔离稳定组”；“低隔离急升组”和“高隔离缓升组”个体年龄更大，女性比例更高，且以初中及以下学历为主。衰弱轨迹中，“衰弱前期稳定组”占比最高，“衰弱加重组”参与者多为高龄、女性、农村居住者，且多数为初中及以下学历；而“健康稳定组”人群相对较年轻，具有较高比例的高中及以上学历。
2.4　社会隔离轨迹的多项logistic回归分析
依据轨迹水平及变化趋势，将社会隔离轨迹中的“低隔离急升组”、“中度隔离稳定组”和“高隔离缓升组”定义为“不利轨迹”，而“低隔离稳定组”作为参照组。多项logistic回归结果表明，年龄增长显著增加进入三类“不利轨迹”的可能性（P<0.001）。性别差异较为明显，男性进入“低隔离急升组”和“高隔离缓升组”的风险均低于女性（P<0.001）。与农村相比，城市居住者更易进入“低隔离急升组”和“高隔离缓升组”（P<0.01）。教育水平具有明显的保护作用，高中及以上文化程度者进入“中度隔离稳定组”和“高隔离缓升组”的可能性显著降低（P<0.01）。生活方式因素整体影响较弱，仅在 “中度隔离稳定组”中呈现轻度保护效应。（见表3）
2.5　衰弱轨迹的多项logistic回归分析
多变量回归结果见表4。年龄每增加1岁，进入“衰弱前期稳定组”和“衰弱加重组”的风险分别增加5%和10%（P<0.001）。男性进入上述轨迹组的可能性显著低于女性（P<0.001）。与农村相比，城市居住者进入“衰弱前期稳定组”和“衰弱加重组”的风险更高，其中“衰弱加重组”的关联更为显著（OR=1.64，P<0.001）。教育水平具有稳定的保护效应，高中及以上学历者均可显著降低进入这两类衰弱轨迹的可能性（OR范围：0.27~0.68，P<0.01）。吸烟与 “衰弱前期稳定组”相关（OR=1.18，P=0.019），而饮酒与降低“衰弱加重组”风险相关（OR=0.76，P=0.002）。
2.6　社会隔离和衰弱的双轨迹
卡方检验结果显示，社会隔离与衰弱轨迹的分布差异具有统计学意义（χ2=141.14，df=6，P<0.001）。在不同社会隔离轨迹下，个体主要分布于“衰弱前期稳定组”，其中 “中度隔离稳定组”比例最高（πk｜j=0.55）；而“高隔离缓升组”进入“衰弱加重组”的比例相对更高（πk｜j=0.30）。见表5。在不同衰弱轨迹下,个体主要分布于“中度隔离稳定组”，其中“衰弱加重组”对应比例最高（πj｜k=0.56），其次为“低隔离稳定组”（πj｜k=0.27）。见表6。联合概率结果进一步表明，“中度隔离稳定组”与“衰弱前期稳定组”的重叠最为显著（πjk=0.29）。见表7。
3　讨论
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本文基于CHARLS全国纵向队列，分别识别出社会隔离的四条轨迹及衰弱的三条轨迹，呈现出显著的组别差异与随时间的异质性变化。logistic回归显示，社会隔离轨迹中，年龄增加普遍提高进入三类“不利轨迹”的风险，女性与城市居住者更易聚集于“低隔离急升组”和“高隔离缓升组”，高中及以上学历在“中度隔离稳定组”和“高隔离缓升组”中具有显著保护效应；衰弱轨迹中，年龄增长、女性和城市居住者显著提高进入“衰弱前期稳定组”和“衰弱加重组”的可能性，而高中及以上学历在两类衰弱轨迹中均呈现稳定的保护作用。联合概率显示，“中度隔离稳定组—衰弱前期稳定组” 是最主要的联合轨迹组合。
这种对应关系与既往证据一致。Hanlon等系统综述指出，孤独与社会隔离会加速衰弱进展并降低恢复潜力[19]；Zhang的纵向研究发现，持续隔离显著增加衰弱风险[20]。本研究发现“中度隔离稳定—衰弱前期稳定”为最主要的联合轨迹，提示在一般老年群体中，中的水平且持续存在的隔离状态，往往与衰弱的早期阶段并行。国内研究也证明社会隔离可通过孤独感间接影响衰弱[4-5]。
社会隔离与衰弱的关联可能涉及多重机制。隔离个体常伴随体力活动减少、不健康饮食及医疗依从性较差，从而加速功能衰退[22-23]；长期孤独引发的心理应激亦可激活炎症反应与神经内分泌失衡，削弱机体储备[24]。本研究中“高隔离缓升组”显著倾向进入“衰弱加重组”，即为上述机制的现实体现。与此同时，衰弱加重也会限制个体的活动范围和社会参与，进一步强化其隔离水平[24]。本研究观察到的社会隔离与衰弱轨迹之间的联合分布特征，从纵向结构上反映了二者在行为、心理和生理通路上的相互影响，为理解隔离与衰弱的共同演进过程提供了补充性证据。
结合本研究轨迹结果可见，“中度隔离稳定组”与“衰弱前期稳定组”是最主要的联合模式，表明相当一部分中老年人长期处于中度社会隔离水平并同步维持在衰弱的早期阶段，该类人群处于社会联系弱化与身体功能下降的双重风险初期，具有较高的可逆性，也是社区预防衰弱与延缓功能衰退的关键干预窗口。在社区健康管理中，可通过开展丰富的社区参与活动、加强邻里支持与志愿陪伴，帮助该人群维持日常的社会联结；同时依托家庭医生团队在居家环境中实施简便的肌力和平衡训练，以保持其基本身体功能。建议将孤独和抑郁筛查纳入常规随访，并结合必要的心理支持和慢病管理，降低多重风险叠加的可能性。通过建立稳定的社会与健康支持体系，可提升早期识别与持续管理的能力，并有助于推动预防导向的老年健康管理实践。
本研究存在局限：其一，社会隔离测量主要依据客观指标，未纳入主观孤独感；其二，研究为观察性设计，因果推断仍需进一步验证。其三，本研究在轨迹识别后采用条件概率和联合概率分析社会隔离与衰弱的动态关联，但不同模型间的轨迹分组可能受模型设定、类别选择等因素影响，轨迹划分的敏感性仍需在更多数据与模型下进一步比较，以提高结果的稳健性。未来研究可结合更丰富的心理社会指标与多源随访数据，进一步阐明社会隔离与衰弱的共同演进模式。
基金
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  • 江苏省中医药科技发展计划专题研究项目(ZT202202)
  • 江苏高校“青蓝工程”
  • 江苏省教育科学规划课题（重点项目）(B-b/2024/01/107)
  • 南京中医药大学养老服务与管理学院（养老产业学院）专项研究项目(2024YLFWYGL016)
文献
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2026年第53卷第6期
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doi: 10.20043/j.cnki.MPM.202509357
  • 接收时间：2025-09-22
  • 首发时间：2026-11-02
  • 出版时间：2026-03-25
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  • 收稿日期：2025-09-22
基金
江苏省中医药科技发展计划专题研究项目(ZT202202)
江苏高校“青蓝工程”
江苏省教育科学规划课题（重点项目）(B-b/2024/01/107)
南京中医药大学养老服务与管理学院（养老产业学院）专项研究项目(2024YLFWYGL016)
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    南京中医药大学养老服务与管理学院，江苏 南京 210023

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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