我国6省≥60岁社区老年人日常活动能力受损状况及慢性病与其关系的前瞻性队列研究

Impairment of activities of daily living and its relationship with chronic diseases in the elderly aged≥60 years in communities:a prospective cohort study in 6 provinces in China

目的探讨我国6省≥60岁社区老年人日常活动能力(ADL)受损状况,并分析慢性病与ADL受损发生的关系。方法数据来源于2015—2018年老年期重点疾病预防和干预项目。该项目采用多阶段分层整群随机抽样的方法,于2015年在全国6个省(直辖市、自治区)共抽取约24000名≥60岁老年人开展基线调查,2017和2018年分别进行了追踪随访。采用Katz指数量表评估老年人ADL。通过Joinpoint回归模型分析不同年份ADL受损率的变化趋势,采用logistic回归分析慢性病与ADL受损发生的关系。结果共纳入有效数据20180人,平均年龄(69.99±6.65)岁,其中男性占43.90%。Joinpiont回归模型分析显示,ADL受损率随着时间的推移逐渐增加,队列人群2015年总受损率为4.49%,2018年后上升到9.99%[年度变化百分比(APC)=30.53%,t=446.00,P=0.001]。经过3年随访,研究对象19273人中有1642人新发生ADL受损,累计发生率8.52%[95%置信区间(CI):8.13~8.91]。不同年龄、性别、城乡、婚姻状况、文化程度、居住状况、既往职业之间老年人ADL受损发生率比较,差异均有统计学意义(均P<0.001);logistic回归分析显示,患1种疾病和患2种及以上疾病的老年人ADL受损发生风险分别是不患病的老年人群的1.30倍[比值比(OR)=1.30,95%CI:1.13~1.49]和2.06倍(OR=2.06,95%CI:1.80~2.35);心脑血管系统疾病、糖尿病和呼吸系统疾病的患者中ADL受损发生风险是未患心脑血管系统疾病、未患糖尿病和未患呼吸系统疾病的1.30倍(OR=1.30,95%CI:1.16~1.44)、1.22倍(OR=1.22,95%CI:1.02~1.45)和1.60倍(OR=1.60,95%CI:1.34~1.90);进一步分析发现,患脑卒中和慢性支气管炎(或肺气肿)与ADL受损密切相关,OR值分别为2.87(95%CI:2.36~3.49)和1.57(95%CI:1.30~1.90)。结论我国6省≥60岁社区老年人ADL受损率随时间推移逐年上升。心脑血管疾病、慢性呼吸系统疾病或共病均会显著增加ADL受损发生的风险。应继续加强社区老年人群的慢性病管理。

Objective To explore the prevalence of impairment of activities of daily living(ADL)in the elderly aged≥60 years in communities in China,and analyze the impact of chronic diseases on impaired ADL.Methods The data from the Project of Prevention and Intervention on Neurodegenerative Disease for Elderly in China(2015−2018)were used.By multistage stratified cluster random sampling method,about 24,000 people aged≥60 years in 6 provinces(municipalities and autonomous regions)of China were selected for a baseline survey in 2015,and the follow-up visits were conducted in 2017 and 2018,respectively.Katz index scale was used to assess ADL in the elderly.The trend of ADL impairment rate in different years was analyzed by Joinpoint regression model,and the relationship between chronic diseases and the ADL impairment was analyzed by logistic regression model.Results Valid data were collected from 20180 persons with a mean age of(69.99±6.65),men accounted for 43.90%.Joinpiont regression analysis showed a gradual increase in the rate of ADL impairment over time,with the total impairment rate of 4.49%in 2015 and 9.99%in 2018,showing an upward trend[annual change percentage(APC)=30.53%,t=446.00,P=0.001].After three years of follow-up,a total of 1,642 new ADL impairments were observed in 19,273 study participants,with a cumulative incidence of 8.52%[95%confidence interval(CI):8.13–8.91].The differences in the incidence of impaired ADL between men and women,between urban residents and rural residents,among people in different age groups and among people with different marital status,education levels,residence status and occupations were significant(P<0.001).Logistic regression analyses showed that the prevalence of impaired ADL was 1.30 times higher in the elderly with 1 disease[odds ratio(OR)=1.30,95%CI:1.13–1.49]and 2.06 time higher in those with 2 or more diseases(OR=2.06,95%CI:1.80–2.35)than in the elderly without disease;the incidence of impaired ADL was 1.30 times higher(OR=1.30,95%CI:1.16–1.44),1.22 times higher(OR=1.22,95%CI:1.02–1.45),and 1.60 times higher(OR=1.60,95%CI:1.34–1.90)in the elderly with cardiovascular system disease,diabetes mellitus and respiratory disease than in the elderly without these diseases.Further analysis found that having stroke and chronic bronchitis(or emphysema)were strongly associated with impaired ADL with OR of 2.87(95%CI:2.36–3.49)and 1.57(95%CI:1.30–1.90),respectively.Conclusion The prevalence of impaired ADL in the elderly aged≥60 years in communities in China increased over time.Cardiovascular and cerebrovascular diseases,chronic respiratory diseases,or co-morbidities all significantly increased the risk for developing impaired ADL.Chronic disease management should be further strengthened for the elderly in communities.