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Article(id=1324078089139007827, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509175, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1757692800000, receivedDateStr=2025-09-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614416632, onlineDateStr=2026-11-02, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614416632, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614416632, creator=13701087609, updateTime=1793614416632, updator=13701087609, issue=Issue{id=1324078037817504735, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614404396, creator='13701087609', updateTime=1793614474144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078330420527919, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078330420527920, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=552, endPage=556, ext={EN=ArticleExt(id=1324078089365500244, articleId=1324078089139007827, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of chronic disease comorbidity on health-related quality of life among older adults: the chain mediating effect of sleep duration and depressive symptoms, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the chain mediating role of sleep duration and depressive symptoms in the relationship between chronic disease comorbidities and health-related quality of life among older adults, and to provide evidence for promoting healthy aging.

Methods

Based on data from the 2020 China Health and Retirement Longitudinal Survey (CHARLS),a total of 6 673 older adults aged ≥60 years were included. Health-related quality of life and depressive symptoms were measured using the EQ-5D-3L and CESD-10 scales, respectively. The chain mediating effect between sleep duration and depressive symptoms was examined using Model 6 of the Process 4.1 plugin in SPSS.

Results

The prevalence of comorbidities of chronic diseases among older adults over 60 years old was 57.9%, and comorbidities of chronic diseases were significantly negatively associated with health-related quality of life (β=-0.279, P<0.001). Sleep duration was positively correlated with health-related quality of life (β=0.035, P<0.05). Depressive symptoms were significantly negatively associated with health-related quality of life (β=-0.525, P<0.001), and the chain mediating effect of sleep duration and depressive symptoms between chronic disease comorbidity and health-related quality of life was significant (β=-0.004, 95% CI: -0.006~ -0.003). The total mediating effect and the chain mediating effect accounted for 40.1% and 4.1% of the total effect, respectively.

Conclusion

Sleep duration and depressive symptoms play a chain mediating role between chronic disease comorbidities and the health-related quality of life of the older adults. Paying attention to the sleep quality and mental health management of elderly patients with chronic disease comorbidities can effectively improve their quality of life and promote the process of healthy aging.

, authors=Yong-jin ZHAI, Ying HAN, Jia-xin BAO, authorsList=Yong-jin ZHAI, Ying HAN, Jia-xin BAO, authorCompany=null, correspAuthors=Ying HAN, 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=1324078092179878233, articleId=1324078089139007827, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=慢性病共病对老年人健康相关生命质量的影响——睡眠时长和抑郁症状的链式中介作用, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

探讨睡眠时长和抑郁症状在慢性病共病和老年人健康相关生命质量间的链式中介机制，为推进健康老龄化提供依据。

方法

基于2020年中国健康与养老追踪调查数据选取≥60岁的老年人(n=6 673)，采用欧洲五维健康量表(EQ-5D-3L)、CESD-10量表分别测量老年人健康相关生命质量和抑郁症状；使用SPSS中Process 4.1插件模型6检验睡眠时长和抑郁症状间的链式中介效应。

结果

60岁以上老年人慢性病共病患病率57.9%，慢性病共病与健康相关生命质量呈显著负向关联(β=-0.279，P<0.001)；睡眠时长与健康相关生命质量呈正向关联(β=0.035, P<0.05)；抑郁症状与健康相关生命质量呈显著负向关联(β=-0.525，P<0.001)，睡眠时长和抑郁症状在慢性病共病和健康相关生命质量间的链式中介效应显著(β=-0.004，95% CI:-0.006～-0.003)，总中介效应和链式中介效应在总效应中分别占40.1%和4.1%。

结论

睡眠时长与抑郁症状在慢性病共病与老年人健康相关生命质量之间起链式中介作用，关注老年慢性病共病患者睡眠质量和心理健康管理，可有效提高其生活质量，推动健康老龄化进程。

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翟永金（2002—)，男，硕士在读，研究方向：社会医学与卫生事业管理

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韩颖，E-mail:
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注：模型中所有路径均控制了年龄、性别、城乡地区、教育程度、婚姻状况、吸烟、饮酒等协变量。

, figureFileSmall=rvgjCPobmJBXRe2ZEP+vMQ==, figureFileBig=1InQGfH5M5wH3YjVDqeiMA==, tableContent=null), ArticleFig(id=1324078098060292472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=EN, label=Table 1, caption=

Comparison of the basic characteristics of comorbidities with chronic diseases and those without chronic diseases［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非慢性病共病组(n=2 809)慢性病共病组(n=3 864)Z/χ2值P 值
人口学特征
年龄（岁）66.0(63.0,71.0)67.0(63.0,71.0)-4.640a<0.001
性别17.523b<0.001
男1 574(56.0)1 965(50.9)
女1 235(44.0)1 899(49.1)
城乡地区19.861b<0.001
城市884(31.5)1 419(36.7)
农村1 925(68.5)2 445(63.3)
婚姻状况0.2350.628
有配偶2 285(81.3)3 125(80.9)
无配偶524(18.7)739(19.1)
教育程度5.8550.119
未接受教育708(25.2)897(23.2)
小学及以下1 287(45.8)1 807(46.8)
初中-高中780(27.8)1 094(28.3)
大专及以上34(1.2)66(1.7)
健康行为特征
当前吸烟3.987b0.046
否1 512(53.8)2 175(56.3)
是1 297(46.2)1 689(43.7)
当前饮酒30.229b<0.001
否1 688(60.1)2 575(66.6)
是1 121(39.9)1 289(33.4)
健康结局特征
抑郁症状评6.0(3.0,11.0)8.0(4,14)-13.140a<0.001
睡眠时间（h）6.0(5.0,8.0)6.0(5.0,7.0)-9.357a<0.001
健康效用值0.869(0.783,0.961)0.783(0.642,0.875)-21.771a<0.001
), ArticleFig(id=1324078098223870329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=CN, label=表1, caption=

慢性病共病者和非慢性病共病者基本特征比较［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非慢性病共病组(n=2 809)慢性病共病组(n=3 864)Z/χ2值P 值
人口学特征
年龄（岁）66.0(63.0,71.0)67.0(63.0,71.0)-4.640a<0.001
性别17.523b<0.001
男1 574(56.0)1 965(50.9)
女1 235(44.0)1 899(49.1)
城乡地区19.861b<0.001
城市884(31.5)1 419(36.7)
农村1 925(68.5)2 445(63.3)
婚姻状况0.2350.628
有配偶2 285(81.3)3 125(80.9)
无配偶524(18.7)739(19.1)
教育程度5.8550.119
未接受教育708(25.2)897(23.2)
小学及以下1 287(45.8)1 807(46.8)
初中-高中780(27.8)1 094(28.3)
大专及以上34(1.2)66(1.7)
健康行为特征
当前吸烟3.987b0.046
否1 512(53.8)2 175(56.3)
是1 297(46.2)1 689(43.7)
当前饮酒30.229b<0.001
否1 688(60.1)2 575(66.6)
是1 121(39.9)1 289(33.4)
健康结局特征
抑郁症状评6.0(3.0,11.0)8.0(4,14)-13.140a<0.001
睡眠时间（h）6.0(5.0,8.0)6.0(5.0,7.0)-9.357a<0.001
健康效用值0.869(0.783,0.961)0.783(0.642,0.875)-21.771a<0.001
), ArticleFig(id=1324078098500694394, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=EN, label=Table 2, caption=

Partial correlation analysis of comorbidity of chronic diseases with health-related quality of life, sleep duration, and depressive symptoms (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠时长抑郁症状慢性病共病HRQoL
睡眠时长1
抑郁症状-0.193**1
慢性病共病-0.107**0.168**1
HRQoL0.141**-0.531**-0.235**1
), ArticleFig(id=1324078100090335611, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=CN, label=表2, caption=

慢性病共病与HRQoL、睡眠时长、抑郁症状的偏相关性分析(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠时长抑郁症状慢性病共病HRQoL
睡眠时长1
抑郁症状-0.193**1
慢性病共病-0.107**0.168**1
HRQoL0.141**-0.531**-0.235**1
), ArticleFig(id=1324078100182610300, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=EN, label=Table 3, caption=

Regression results of the multiple mediation model (standardized regression coefficients)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1：睡眠时长模型2：抑郁症状模型3：HRQoL
βtβtβt
年龄0.0452.550*-0.025-1.505-0.101-7.076***
性别-0.057-2.977**0.0894.950***-0.041-2.658**
城乡地区0.0462.537*0.1549.087***-0.015-1.031
婚姻状况-0.043-2.417*0.0734.390***0.0271.912
教育程度-0.022-1.199-0.116-6.590***0.0704.611***
慢性病共病-0.218-6.393***0.3049.403***-0.279-9.976***
睡眠时长——-0.167-10.445***0.0352.508*
抑郁症状————-0.525-36.493***
R值0.1550.3610.607
R2值0.0240.1300.368
F值9.559***52.463***185.679***
), ArticleFig(id=1324078100312633725, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=CN, label=表3, caption=

多重中介模型回归分析结果(标准化回归系数)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1：睡眠时长模型2：抑郁症状模型3：HRQoL
βtβtβt
年龄0.0452.550*-0.025-1.505-0.101-7.076***
性别-0.057-2.977**0.0894.950***-0.041-2.658**
城乡地区0.0462.537*0.1549.087***-0.015-1.031
婚姻状况-0.043-2.417*0.0734.390***0.0271.912
教育程度-0.022-1.199-0.116-6.590***0.0704.611***
慢性病共病-0.218-6.393***0.3049.403***-0.279-9.976***
睡眠时长——-0.167-10.445***0.0352.508*
抑郁症状————-0.525-36.493***
R值0.1550.3610.607
R2值0.0240.1300.368
F值9.559***52.463***185.679***
), ArticleFig(id=1324078100396519806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=EN, label=Table 4, caption=

Significance test of mediating effect

, figureFileSmall=null, figureFileBig=null, tableContent=
效应分类效应量(95%CI)效应占比(%)
总效应-0.103(-0.114~-0.010)100.0
直接效应-0.062(-0.074~-0.050)59.9
总间接效应-0.041(-0.050~-0.033)40.1
慢性病共病→睡眠时长→
HRQoL		-0.002(-0.003~-0.001)1.7
慢性病共病→抑郁症状→
HRQoL		-0.036(-0.043~-0.028)34.4
慢性病共病→睡眠时长→
抑郁症状→HRQoL		-0.004(-0.006~-0.003)4.1
), ArticleFig(id=1324078100480405887, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078089139007827, language=CN, label=表4, caption=

中介效应显著性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
效应分类效应量(95%CI)效应占比(%)
总效应-0.103(-0.114~-0.010)100.0
直接效应-0.062(-0.074~-0.050)59.9
总间接效应-0.041(-0.050~-0.033)40.1
慢性病共病→睡眠时长→
HRQoL		-0.002(-0.003~-0.001)1.7
慢性病共病→抑郁症状→
HRQoL		-0.036(-0.043~-0.028)34.4
慢性病共病→睡眠时长→
抑郁症状→HRQoL		-0.004(-0.006~-0.003)4.1
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翟永金 , 韩颖 , 暴嘉欣
现代预防医学 | 临床与预防 2026,53(3): 552-556
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现代预防医学 |临床与预防 2026 , 53 (3) : 552 -556
慢性病共病对老年人健康相关生命质量的影响——睡眠时长和抑郁症状的链式中介作用
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翟永金（2002—)，男，硕士在读，研究方向：社会医学与卫生事业管理

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翟永金（2002—)，男，硕士在读，研究方向：社会医学与卫生事业管理

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翟永金, 韩颖 , 暴嘉欣
作者信息
  • 山西医科大学管理学院，山西 晋中 030600
通讯作者:
韩颖，E-mail:
作者简介:

翟永金（2002—)，男，硕士在读，研究方向：社会医学与卫生事业管理

The impact of chronic disease comorbidity on health-related quality of life among older adults: the chain mediating effect of sleep duration and depressive symptoms
Yong-jin ZHAI, Ying HAN , Jia-xin BAO
Affiliations
  • School of Management, Shanxi Medical University, Jinzhong, Shanxi 030600, China
出版时间: 2026-02-10 doi: 10.20043/j.cnki.MPM.202509175
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摘要
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目的

探讨睡眠时长和抑郁症状在慢性病共病和老年人健康相关生命质量间的链式中介机制，为推进健康老龄化提供依据。

方法

基于2020年中国健康与养老追踪调查数据选取≥60岁的老年人(n=6 673)，采用欧洲五维健康量表(EQ-5D-3L)、CESD-10量表分别测量老年人健康相关生命质量和抑郁症状；使用SPSS中Process 4.1插件模型6检验睡眠时长和抑郁症状间的链式中介效应。

结果

60岁以上老年人慢性病共病患病率57.9%，慢性病共病与健康相关生命质量呈显著负向关联(β=-0.279，P<0.001)；睡眠时长与健康相关生命质量呈正向关联(β=0.035, P<0.05)；抑郁症状与健康相关生命质量呈显著负向关联(β=-0.525，P<0.001)，睡眠时长和抑郁症状在慢性病共病和健康相关生命质量间的链式中介效应显著(β=-0.004，95% CI:-0.006～-0.003)，总中介效应和链式中介效应在总效应中分别占40.1%和4.1%。

结论

睡眠时长与抑郁症状在慢性病共病与老年人健康相关生命质量之间起链式中介作用，关注老年慢性病共病患者睡眠质量和心理健康管理，可有效提高其生活质量，推动健康老龄化进程。

慢性病共病  /  健康相关生命质量  /  抑郁症状  /  链式中介作用
Objective

To investigate the chain mediating role of sleep duration and depressive symptoms in the relationship between chronic disease comorbidities and health-related quality of life among older adults, and to provide evidence for promoting healthy aging.

Methods

Based on data from the 2020 China Health and Retirement Longitudinal Survey (CHARLS),a total of 6 673 older adults aged ≥60 years were included. Health-related quality of life and depressive symptoms were measured using the EQ-5D-3L and CESD-10 scales, respectively. The chain mediating effect between sleep duration and depressive symptoms was examined using Model 6 of the Process 4.1 plugin in SPSS.

Results

The prevalence of comorbidities of chronic diseases among older adults over 60 years old was 57.9%, and comorbidities of chronic diseases were significantly negatively associated with health-related quality of life (β=-0.279, P<0.001). Sleep duration was positively correlated with health-related quality of life (β=0.035, P<0.05). Depressive symptoms were significantly negatively associated with health-related quality of life (β=-0.525, P<0.001), and the chain mediating effect of sleep duration and depressive symptoms between chronic disease comorbidity and health-related quality of life was significant (β=-0.004, 95% CI: -0.006~ -0.003). The total mediating effect and the chain mediating effect accounted for 40.1% and 4.1% of the total effect, respectively.

Conclusion

Sleep duration and depressive symptoms play a chain mediating role between chronic disease comorbidities and the health-related quality of life of the older adults. Paying attention to the sleep quality and mental health management of elderly patients with chronic disease comorbidities can effectively improve their quality of life and promote the process of healthy aging.

Multimorbidity  /  Health-related quality of life  /  Depressive symptoms  /  Chain mediating effect
翟永金, 韩颖, 暴嘉欣. 慢性病共病对老年人健康相关生命质量的影响——睡眠时长和抑郁症状的链式中介作用. 现代预防医学, 2026 , 53 (3) : 552 -556 . DOI: 10.20043/j.cnki.MPM.202509175
Yong-jin ZHAI, Ying HAN, Jia-xin BAO. The impact of chronic disease comorbidity on health-related quality of life among older adults: the chain mediating effect of sleep duration and depressive symptoms[J]. Modern Preventive Medicine, 2026 , 53 (3) : 552 -556 . DOI: 10.20043/j.cnki.MPM.202509175
正文
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《2023国家老龄事业发展公报》显示，随着我国进入中度老龄化社会，老年人群的健康问题日益凸显[1]。据统计，约有1.8亿老年人罹患慢性病，超过三分之一的老年人存在两种及以上慢性病共存的情况[2]。慢性病现已成为老年人面临的最主要的健康威胁，由于多病并存、多种影响因素交织，慢性病共病成为威胁老年人生命质量的重大公共卫生问题[3]。健康老龄化核心内涵是发展和维护老年健康生活所需的功能发挥的过程，要推进健康中国建设，实施积极应对人口老龄化国家战略，健康老龄化不仅要体现生命的长度，更要突出生命的质量[4]。健康相关生命质量 (health-related quality of life,HRQoL)作为衡量个体健康状态的一项综合性指标,涵盖生理、心理及社会功能等多个维度，能有效反映老年人对自身健康和生活质量的主观感知[5]。
睡眠是维持身心健康的基础，其质量影响老年人的生理机能和免疫状态，睡眠质量差与多种不良健康结局有关[6]。抑郁症状在老年群体中较为普遍，不仅损害心理健康，还可能加剧慢性病的进展[7]。已有研究表明，睡眠时长和抑郁症状在许多健康问题中发挥着中介作用[8-9]。但关于睡眠与抑郁在慢性病共病影响HRQoL路径的作用尚缺乏深入探讨。本研究旨在探讨睡眠时长和抑郁症状在慢性病共病影响HRQoL过程中的链式中介作用，为制定针对老年人的健康干预策略提供理论依据。
1　对象与方法
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1.1　数据来源
本研究数据来源于2020年开展的中国健康与养老追踪调查(China Health and Retirement Longitudinal Survey，CHARLS)。该调查已通过北京大学生物医学伦理委员会审批(IRB00001052-11015)，所有参与者均提供了知情同意。在本研究中提取年龄60岁及以上的老年人作为研究对象，去除研究变量缺失值后获得6 673个样本量。
1.2　变量选择
1.2.1　慢性病共病(multimorbidity)
本研究将慢性病共病定义为：经医生诊断确诊，同时罹患两种或两种以上特定慢性病的状态作为自变量。筛选提取CHARLS数据库中的15种慢性病，纳入的慢性病包括：高血压、血脂异常、糖尿病、癌症、慢性肺部疾病、肝脏疾病、心脏疾病、中风、肾脏疾病、胃或消化系统疾病、关节炎或风湿病、哮喘。满足慢性病共病定义的老年人赋值为 1；其他老年人赋值为 0。
1.2.2　HRQoL
老年人生命质量评价采用使用欧洲五维健康量表(three-level EuroQoL five-dimensions，EQ-5D-3L)，该量表包含五个维度，每个维度又包含三个等级。参照童迁[10]研究，五个维度的测量中，行动能力可通过CHARLS问卷中的“购物是否有困难”“如厕是否有困难”加以体现；自我照顾能力包括“穿衣”“洗澡”“进食”“上下床”是否存在困难；日常活动能力涵盖“做家务”“做饭”“打电话”等活动的困难程度；疼痛/不适则由“是否经常因疼痛而感到难受”进行衡量；焦虑维度则以“是否因琐事而感到烦恼”作为指标。本研究采用刘国恩[11]等根据中国人群的偏好构建的健康效用值量化HRQoL，健康效用值是基于中国人群的效用值积分体系，将个体在五个维度的健康状况转化为一个介于0(死亡)到1(完全健康)之间的单一指数，用以综合量化其HRQoL水平。其中健康效用值范围为[-0.149,1]，分值越大，表明个体生命质量越好。
1.2.3　睡眠时长
老年人睡眠时长依据问卷中“过去一个月内，平均每晚实际入睡的时间约为多少小时？”的条目，以自我报告的睡眠时长进行测量，睡眠时长是个体评估睡眠状况的一个重要客观指标。
1.2.4　抑郁症状
老年人抑郁症状评价采用简版流调中心抑郁量表CESD-10量表[12]，共包括10个问题，每道问题答案为4个等级，分别赋值0～3，并对“我对未来充满希望”和“我很愉快”两个正向问题进行反向得分操作，将10道题的分数加总测算出老年人抑郁量表评分，最终得分在0～30分之间，总分≥10分判定为存在抑郁症状。分值越大，表明个体在抑郁症状方面的严重程度越高。本研究中，量表Cronbach α系数为0.712。表明其可靠性良好。
1.2.5　协变量
本研究将年龄、性别、居住地区、婚姻状况、受教育水平、吸烟、饮酒及运动情况等人口学变量作为协变量纳入分析。
1.3　统计学方法
采用SPSS 27.0统计软件进行数据分析。分类变量以频数和百分比描述，连续变量以（）表示；若不符合正态分布，则采用中位数及四分位数间距［M（P25，P75）］描述。两组比较中，连续型变量使用Mann - Whitney U检验，计数资料采用χ2检验。慢性病共病、睡眠时长、抑郁症状与HRQoL之间的关系通过控制协变量的偏相关分析探讨。进一步利用Process宏程序Model6检验睡眠时长与抑郁症状在慢性病共病与HRQoL关系中的链式中介作用。双侧检验，检验水准α= 0.05。
2　结果
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2.1　共同方法偏差分析
本研究采用Harman单因子检验法，以第一因子方差解释率占方差总解释率的百分比为判断依据。结果显示，第一个因子的方差解释率为29.54%，小于40%的标准，没有单一因子占据大部分变异，表明不存在明显的共同方法偏差，研究数据可进一步分析。
2.2　研究对象基本情况
在纳入研究的6 673名的老年人中，其中男性3 539名(53.1%)，女性3 134名(43.9%)；老年慢性共病患者平均年龄为67岁，慢性病共病患病率为57.9%(3 864/6 673)，分别占比男性和女性的50.9%(1 965/6 673)和49.1%(1 899/6 673)。共病组以农村2 445名(63.3%)为主，在年龄、性别、居住地、吸烟饮酒行为、心理健康、睡眠及生命质量方面与非慢性病共病组差异均存在统计学意义(P<0.05)，其健康效用值显著低于非共病组(P<0.001)，抑郁症状更严重(P<0.001)。见表1。
2.3　偏相关性分析
本研究采用控制协变量的偏相关分析检验了睡眠时长、抑郁症状、慢性病共病与HRQoL之间的关系，研究结果表明各变量间存在显著相关性。睡眠时长与抑郁症状、慢性病共病呈显著负相关(r=-0.193，P<0.01; r=-0.107, P<0.01)；抑郁症状与慢性病共病呈显著正相关(r=0.168, P<0.01)；HRQoL与睡眠时长呈显著正相关(r=0.141, P<0.01)；HRQoL与抑郁症状、慢性病共病(r=-0.531, P<0.01; r=-0.235, P<0.01)均呈显著负相关。见表2。
2.4　链式中介效应模型构建
在控制年龄、性别等人口学变量的基础上,采用Process宏程序中的Model 6,通过5 000次的bootstrap抽样量,在95%置信区间来检验睡眠时长和抑郁症状在老年人慢性病共病和HRQoL之间的链式中介反应。回归系数的显著性通过95%置信区间进行检验，当置信区间不跨越零时，即认为中介效应具有统计学意义。
多重中介模型回归分析表示，慢性病共病显著负向关联睡眠时长(β=-0.218, P<0.001)；慢性病共病显著正向关联抑郁症状(β=0.304, P<0.001)；慢性病共病显著负向关联HRQoL(β=-0.279, P<0.001)；睡眠时长显著负向关联抑郁症状(β=-0.167, P<0.001)；睡眠时长正向关联HRQoL(β=0.035, P<0.05)；抑郁症状显著负向关联HRQoL(β=-0.525, P<0.001)。见图1和表3。
中介效应检验结果显示，所有路径95% CI不包括零，睡眠时长和抑郁症状在慢性病共病和老年人健康相关生命质量之间存在链式中介效应。总中介效应值为-0.041(95% CI: -0.049～-0.033)，占总效应的40.1%；慢性病共病到HRQoL的直接效应值为-0.062(95% CI: -0.074～-0.050)，占总效应的59.9%。见表4。
3　讨论
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本研究结果显示，睡眠时长和抑郁症状在慢性病共病与HRQoL之间发挥链式中介作用。慢性病共病不仅直接降低老年人的生命质量，还可能通过影响睡眠规律、引发抑郁情绪，间接加剧健康结局的恶化。
本研究发现，我国60岁及以上老年人的慢性病共病检出率为57.90%，其中合并慢性病共病者的生命质量显著低于单一慢性病患者或无慢性病者，与既往研究一致，慢性病共病是我国老年人多维健康状况的重要危险因素[13]。老年人罹患慢性病共病后直接正向影响其生活质量，由于慢性病病程较长、病情迁延持久、疾病负担重、治愈率低等特点[14]，多种慢性病交织影响老年患者的日常生活能力与心理健康，导致出现焦虑、抑郁症状等状况[15]。
本研究显示，慢性病共病能够通过睡眠时长中介作用影响老年人生活质量状况。夏高艳研究表明，睡眠时长与慢性病共病罹患风险呈“U”形非线性关联，最佳睡眠时长约为7 h，睡眠时长过短或过长均可能增加慢性病共病风险[6]。可能原因是：一方面，慢性病共病对患者本身产生躯体疼痛，夜间睡眠时长减少，间接影响其生活质量[16]；另一方面，慢性病共病患者可能因社会支持不足、经济压力、缺乏运动或进食困难而加重睡眠障碍，进一步影响生活质量[17]。
本研究显示，慢性病共病能够通过抑郁症状中介作用影响老年人生活质量状况。慢性病共病导致疾病负担加重，需长期投入高昂医疗费用，这种经济压力可能导致患者和家庭陷入困境，促使患者出现抑郁症状[18]；另一方面，研究表明，慢性病共病与日常生活活动能力评分呈负相关，导致患者减少社会参与，加剧抑郁症状的出现[19]。
慢性病共病先后通过睡眠时长与抑郁症状这一链式中介路径预测慢性共病老年人的生命质量，老年患者由于长期受慢性病影响，身体功能受限，容易出现睡眠障碍，导致睡眠时长减少；睡眠不足会进一步加剧患者的抑郁症状，显著降低其HRQoL。综上可知，在慢性病共病影响生命质量的过程中，睡眠时长与抑郁症状发挥了链式中介作用。可通过引导慢性共病老年人心理疏导、提高睡眠质量，整体角度减弱此种中介效应，降低慢性病共病对生命质量的影响，提高其生命质量。本研究结论建议：需构建“医疗-社区-家庭”多方位协同的健康管理模式，其中医疗机构负责慢性病治疗与睡眠、抑郁症状的专业评估干预；社区通过健康宣教手段提升老年人养成科学健康的生活方式和睡眠习惯意识；家庭则提供生活照料与心理情感陪伴，形成“预防-干预-维持”的闭环管理，最大化提升慢性病共病老年人的生命质量。
本研究存在一些局限性。首先，研究数据来源于横断面调查，无法确定慢性病共病、睡眠时长、抑郁症状和HRQoL之间的时间顺序，本横断面研究的结果支持了睡眠时长与抑郁症状在慢性病共病与HRQoL关联中的链式中介作用，但这—关联的方向性仍需未来前瞻性研究加以验证，未来可以通过队列研究进一步探讨因果关系。其次，研究机制较为单一，仅探讨了睡眠时长和抑郁症状的链式中介效应，且睡眠测量主要依赖于自我报告的时长，未能涵盖睡眠质量、结构等其他重要维度，这可能导致对睡眠与健康关联的估计不够全面，而慢性病共病与HRQoL之间的作用影响机制复杂，未来可以进一步探究其他可能存在的中介效应影响路径。
基金
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  • 山西省政府政研室重点招标采购课题(1499002022CCS01906)
  • 区域高等康养教育发展战略与机制研究(2F022024054)
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2026年第53卷第3期
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doi: 10.20043/j.cnki.MPM.202509175
  • 接收时间：2025-09-13
  • 首发时间：2026-11-02
  • 出版时间：2026-02-10
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  • 收稿日期：2025-09-13
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山西省政府政研室重点招标采购课题(1499002022CCS01906)
区域高等康养教育发展战略与机制研究(2F022024054)
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    山西医科大学管理学院，山西 晋中 030600

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Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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