中国中老年人共病发展轨迹及其对新发失能的影响

Multimorbidity developmental trajectory among middle-aged and older adults and its impact on new-onset disability in China

目的探索我国中老年人共病发展轨迹及其对新发失能的影响,以识别具有相似共病发展历程的同质群体,为我国中老年人群的失能风险干预提供依据。方法基于中国健康与养老追踪调查2011-2018年4期数据,采用组基轨迹模型拟合共病发展轨迹,进而采用含时间依存协变量Cox回归模型分析其对新发失能的影响。结果共纳入8580名中老年人,依据中老年共病发展轨迹趋势,可分为无共病型(2136人,24.90%)、新发-发展型(3758人,43.80%)、适度-发展型(2270人,26.45%)和严重-发展型(416人,4.85%)4种类型。适度-发展型和严重-发展型人群中女性、自评健康差、超重/肥胖、单身、居住在农村、家庭年人均支出水平高、发生新发失能的占比较高。调整人口学、行为学协变量后,与新发-发展型相比,严重-发展型(HR=3.132,95%CI:1.884~5.207)的失能风险最高,适度-发展型(HR=1.400,95%CI:1.026~1.909)次之,无共病型(HR=0.631,95%CI:0.424~0.938)最低。结论我国中老年人的共病发展轨迹存在异质性,共病发展轨迹的失能风险随共病水平的升高而增加,提示共病发展轨迹升高是发生失能的危险因素。

Objective To explore the developmental trajectory of multimorbidity and its impact on new-onset disability to identify homogeneous groups with similar multimorbidity developmental courses and to provide evidence for interventions for disability risk among middle-aged and older adults in China.Methods Data was retrospectively collected from China Health and Retirement Longitudinal Study with four consecutive surveys(2011-2018).Group-based trajectory modeling was used to fit multimorbidity developmental trajectories,and the impact of multimorbidity trajectories on new-onset disability was analyzed using the time-dependent Cox regression model.Results A total of 8580 participants were included in current analysis,and four multimorbidity trajectories were identified:no multimorbidity(n=2136,24.90%),newly-developing(n=3758,43.80%),moderate-developing(n=2270,26.45%)and severe-developing(n=416,4.85%).Participants who belong to moderate-developing and severe-developing tended to be female,single,overweight or obese,live in rural areas,have poorer self-rated health and high levels of annual per capita household expenditure,and developed a new-onset disability.After adjusting for demographic and behavioral covariates,compared to the newly-developing,the severe-developing(HR=3.132,95%CI:1.884-5.207)had the highest risk of disability,followed by the moderate-developing(HR=1.400,95%CI:1.026-1.909)and the risk for the no multimorbidity(HR=0.631,95%CI:0.424-0.938)was the lowest.Conclusions There was great heterogeneity in the developmental trajectory of multimorbidity among middle-aged and older adults in China.Data showed that the risk of disability in the developmental trajectory of multimorbidity increases with increasing levels.We think that the elevating developmental trajectory of multimorbidity is a risk factor for developing disability.