摘要： 背景 我國人口老齡化問題嚴重，慢性病共病現(xiàn)象日趨普遍。 目的 以健康生態(tài)學(xué)模型為基礎(chǔ)，系統(tǒng)了解我國老年人發(fā)生慢性病共病的影響因素，為我國老年人慢性病共病問題防控提供參考。 方法 于2021年3月，在中國健康與養(yǎng)老追蹤調(diào)查（CHARLS）的2018年追蹤數(shù)據(jù)庫中選取年齡≥60歲的樣本（n=10 779），剔除研究涉及變量有缺失的樣本后，最終納入樣本7 354例。以是否發(fā)生慢性病共?。ɑ肌?種慢性病）為因變量，根據(jù)健康生態(tài)學(xué)模型的5個維度納入自變量，采用多因素Logistic回歸模型分析老年人發(fā)生慢性病共病的影響因素。 結(jié)果 老年人的慢性病共病發(fā)生率為65.16%（4 792/7 354），患2種慢性病者居多〔32.16%（1 541/4 792）〕，其中發(fā)生率最高的二元慢性病共病組合為高血壓+關(guān)節(jié)炎或風濕病〔16.42%（253/1 541）〕。多因素Logistic回歸分析結(jié)果顯示：對于老年人的慢性病共病發(fā)生風險，女性高于男性〔OR（95%CI）=1.371（1.177，1.596）〕，>70歲者高于60~70歲者〔OR（95%CI）=1.189（1.061，1.333）〕，夜晚睡眠時間為6~8 h者和>8 h者低于<6 h者〔OR（95%CI）分別為0.759（0.678，0.850）、0.686（0.572，0.821）〕，午睡時間為0.5~1.0 h者和>1.0 h者高于<0.5 h者〔OR（95%CI）分別為1.238（1.102，1.391）、1.219（1.604，1.396）〕，對健康感到一般和不太滿意者高于非常滿意者〔OR（95%CI）分別為1.755（1.537，2.004）、5.890（4.930，7.037）〕，城市戶口者高于農(nóng)村戶口者〔OR（95%CI）=1.167（1.036，1.315）〕，居住在中部和西部地區(qū)者高于東部地區(qū)者〔OR（95%CI）分別為1.311（1.158，1.483）、1.491（1.315，1.692）〕，正在工作者低于曾經(jīng)工作過者〔OR（95%CI）=0.768（0.680，0.866）〕，人均年收入>5萬元者高于<2萬元者〔OR（95%CI）=1.413（1.009，1.978）〕。 結(jié)論 我國老年人的慢性病共病發(fā)生率較高，慢性病共病的影響因素是多層次、多維度的，不同的影響因素之間有著復(fù)雜的關(guān)系，建議從個體到環(huán)境多維度加強對慢性病的干預(yù)和管理，提高人群健康水平。

關(guān)鍵詞: 慢性病共病, 老年人, 健康生態(tài)學(xué)模型, 健康社會決定因素, 健康生活方式, 患病率, 影響因素分析

Abstract:

Background

The problem of population aging is serious in China, and chronic diseases comorbidity is becoming more and more common.

Objective

Based on the health ecology model, to systematically understand the main influencing factors of chronic disease comorbidity among the elderly in China, and to provide scientific reference for the prevention and control of chronic disease comorbidity among the elderly in China.

Methods

Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) 2018, a total of 10 779 samples aged ≥60 years were selected in March 2021. After excluding the samples with missing data and unqualified data, a total of 7 354 samples was included in this study. With the occurrence of chronic comorbidities (having ≥2 chronic conditions) as the dependent variable and the inclusion of independent variables according to the 5 dimensions of the health ecology model, a multivariate Logistic regression model was used to analyze the influencing factors of chronic disease comorbidity in the elderly.

Results

Among the elderly≥60 years old in China, the comorbidity rate of chronic diseases was 65.16% (4 792/7 354) , with 32.16% (1 541/4 792) patients suffered from two kinds of chronic diseases, and the diseases with the largest combination of two comorbidities were hypertension with arthritis or rheumatism〔16.42% (253/1 541) 〕. The results of the multivariate Logistic analysis showed that for the risk of comorbidities of chronic diseases in the elderly, females were higher than that in males〔OR (95%CI) =1.371 (1.177, 1.596) 〕, those over 70 years old were higher than those aged 60-70 years old〔OR (95%CI) =1.189 (1.061, 1.333) 〕, those who slept for 6-8 hours or more than 8 hours at night were lower than those who slept for less than 6 hours at night〔OR (95%CI) =0.759 (0.678, 0.850) , OR (95%CI) =0.686 (0.572, 0.821) 〕, those who took nap time of 0.5-1.0 h and over 1.0 h were higher than those of less than 0.5 h 〔OR (95%CI) =1.238 (1.102, 1.391) , OR (95%CI) =1.219 (1.604, 1.396) 〕, those who felt general and less satisfied with their health were higher than those who were very satisfied〔OR (95%CI) =1.755 (1.537, 2.004) , OR (95%CI) =5.890 (4.930, 7.037) 〕, those who registered in urban areas were higher than those in the rural areas〔OR (95%CI) =1.167 (1.036, 1.315) 〕, those living in the central and western regions were higher than those in the eastern region〔OR (95%CI) =1.311 (1.158, 1.483) , OR (95%CI) =1.491 (1.315, 1.692) 〕, those who were working were lower than those who had worked〔OR (95%CI) =0.768 (0.680, 0.866) 〕, and those with annual income > 50 000 per capita were higher than that of less than 20 000 yuan〔OR (95%CI) =1.413 (1.009, 1.978) 〕.

Conclusion

The incidence of chronic diseases comorbidity is higher in the elderly in China. The influencing factors of comorbidity of chronic diseases are multi-level and multi-dimensional. There are complex relationships between different influencing factors, which suggest strengthening multi-dimensional intervention and management of chronic diseases from individual to environment, so as to improve the health level of the population.

Key words: Multiple chronic conditions, Aged, Health ecology model, Social determinants of health, Healthy lifestyle, Prevalence, Root cause analysis

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