中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

Association of multimorbidity patterns with activity of daily living and instrumental activity of dai⁃ly living disability among≥45 years middle⁃aged and elderly population in China

目的聚类中国≥45岁中老年人多重慢性病模式的流行情况,并探讨多重慢性病模式与日常生活能力(activity of daily living,ADL)和工具性日常生活能力(instrumental activity of daily living,IADL)残疾的关联性。方法基于2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据库,以19745名≥45岁中老年人为研究对象,采用双向聚类法(two⁃way clustering framework,TCF)识别非随机多重慢性疾病模式后进行人群聚类,并采用logistic回归分析模型分析多重慢性病模式与ADL和IADL残疾的相互关系。结果中国中老年人多重慢性病患者例数为10941,占55.4%,可聚类为心脑血管-代谢模式、呼吸系统-内脏模式和消化-关节-精神模式,根据多重慢性病模式的关联强度将人群划分为5个多重慢性病关联组。其中,高度关联心脑血管-代谢模式和消化-关节-精神模式人群的ADL和IADL残疾负担最重(OR=4.696,95%CI:4.196~5.255,P<0.001;OR=3.155,95%CI:2.840~3.504,P<0.001),高度关联心脑血管-代谢模式合并中度关联呼吸系统-内脏模式的人群罹患ADL和IADL残疾的风险次之(OR=2.821,95%CI:2.210~3.602,P<0.001;OR=2.662,95%CI:2.120~3.342,P<0.001)。结论中国中老年人群中高度关联心脑血管-代谢模式发生ADL和IADL残疾的风险最高。

Objective To cluster the epidemic situation of multimorbidity patterns in middle⁃aged and elderly people aged 45 years and above in China,and explore the relationship between multimorbidity patterns and activity of daily living(ADL)/instrumental activity of daily living(IADL)disability.Methods Based on the 2018 China Health and Retirement Longitudinal Study(CHARLS),the study included a total of 19745 individuals aged 45 years and older from the middle⁃aged and elderly population.To identify non⁃random multimorbidity patterns,a two⁃way clustering framework(TCF)was utilized for clustering people,while logistic regression was employed to analyze the association between multimorbidity patterns and ADL/IADL disability.Results The number of middle⁃aged and elderly patients with multimorbidity in China was 10941,accounting for 55.4%of the sample,which could be clustered into three patterns:cardio⁃cerebrovascular⁃metabolic pattern,respiratory system⁃visceral pattern and digestion⁃articular⁃mental pattern.According to the association strength of multimorbidity patterns,the population was divided into five multimorbidity association groups.ADL/IADL disability burden was the high⁃est in people with highly related cardio⁃cerebrovascular⁃metabolic pattern and digestion⁃articular⁃mental pattern(OR=4.696,95%CI:4.196-5.255,P<0.001;OR=3.155,95%CI:2.840-3.504,P<0.001).The risk of ADL/IADL disability in people with highly related cardio⁃cerebrovascular metabolic pattern and moderate related respiratory system⁃visceral pattern was the second(OR=2.821,95%CI:2.210-3.602,P<0.001;OR=2.662,95%CI:2.120-3.342,P<0.001).Conclusions The risk of ADL/IADL disability is the highest in middle⁃aged and elderly people with highly related cardio⁃cerebrovascular metabolic patterns.