我国不同性别老年人成功老龄化与死亡的关系研究

目的 了解我国老年人成功老龄化的现状,并探究不同性别老年人成功老龄化及其组成部分与死亡的关系。方法 数据来源为2010—2016年中国健康与养老全国追踪调查（China Health and Retirement Longitudinal Study,CHARLS）数据。采用χ2检验比较不同性别老年人成功老龄化之间的差异;利用Cox比例风险回归模型探讨不同性别老年人成功老龄化与死亡的关系及其差异。结果 无论成功老龄化率和死亡率,女性均高于男性;就女性而言,与成功老龄化人群相比,未成功老龄化人群死亡风险是其2.702倍,低认知功能人群其死亡风险更高;无论男女,患慢性病、功能损失的人群其死亡风险更高。结论 不同性别老年人成功老龄化及其组成部分与死亡关系存在显著差异;相比男性,女性成功老龄化与死亡的关系更加显著;为促进健康老龄化,女性应不断注重心理健康,无论男女,生理健康的改善,有利于降低死亡风险。     

中国8个长寿地区65岁及以上老年人视力不良对死亡风险的影响

目的探讨中国长寿地区≥65岁老年人视力不良与全死因死亡风险的关系。方法数据来源于"中国老年健康影响因素跟踪调查"子队列-"老年健康生物标志物队列研究数据库",本研究选取该项目中2012年的≥65岁老年人的身体测量和死亡指标进行分析,2014年和2017年随访生存结局。采用Cox比例风险回归模型分析视力对死亡风险的影响。按年龄和性别分亚组进一步分析数据。结果共纳入1736名老年人,5年随访期间共有943人死亡,5年死亡率为54.3%。视力不良组的5年死亡率为76.7%,高于视力良好组的47.6%(P<0.001)。校正人口学信息、生活方式、部分疾病因素后,视力不良组5年死亡风险是视力良好组的1.30倍(HR=1.30,95%CI:1.09~1.55)。女性老年人群中,视力不良组的死亡风险是视力良好组的1.48倍(HR=1.48,95%CI:1.20~1.84),而男性老年人的视力与死亡风险无关联(HR=1.02,95%CI:0.72~1.43)。在≥90岁的老年人群中,视力不良人群的死亡风险是视力良好组的1.39倍(HR=1.39,95%CI:1.13~1.70)。而65~79岁和80~89岁老年人的视力与死亡风险均无关联(HR=1.37,95%CI:0.61~3.07;HR=0.95,95%CI:0.61~1.48)。结论视力不良是中国老年人的死亡风险升高的危险因素。     

女性老年人认知障碍与死亡风险的相关性研究

目的 研究女性老年人认知障碍与其死亡风险之间的关系。方法 利用2002-2011年中国老年健康长寿跟踪调查数据,运用Cox回归模型,以是否认知障碍为因变量,调整基线人口学特征（年龄、性别、居住地、民族、婚姻和教育程度）和健康变量（日常生活能力、高血压、中风和糖尿病,以及乐观和快活）,分析女性老年人认知障碍与死亡风险的关系。结果 认知障碍组死亡风险是非认知障碍组的2.22倍（HR=2.22,95%CI:2.08~2.37,P<0.001）;在校正混杂因素后,认知障碍仍然与高死亡风险相关联（HR=1.14,95%CI:1.05~1.22,P=0.001））,农村女性认知障碍与高死亡风险无统计学意义（HR=1.09,95%CI:0.99~1.20,P=0.075）,城镇女性认知障碍仍然与高死亡风险相关（HR=1.21,95%CI:1.08~1.36,P=0.001）。结论 女性老年人认知障碍与高死亡风险相关,且具有城乡差异。通过干预影响认知障碍发生发展的因素,能够在一定程度上提高我国老年人的健康寿命和生活质量。     

徐州市2005—2012年HIV/AIDS病例的生存状况及影响因素分析

目的 探讨徐州市确诊HIV/AIDS病例的生存状况及死亡的影响因素。方法 收集徐州市HIV/AIDS病例信息,采用寿命表法计算生存率,应用Kaplan-Meier法描述比较不同亚组的生存曲线,利用Cox比例风险回归模型计算死亡的影响因素风险比值(HR)。结果 2005—2012年共报告现住址为徐州市的HIV/AIDS病例490例,男性占63.47%,女性占36.53%,病例平均生存时间(13.13±0.36)年;接受抗病毒治疗404例(82.45%);病例第1、5、10、15年累积生存率分别为0.82、0.73、0.70、0.66。多因素Cox风险模型分析结果显示：女性死亡风险低于男性(HR=0.564,95%CI:0.376～0.844);与异性传播相比,输血传播人群死亡风险较高(HR=1.877,95%CI:1.205～2.924);与基线CD4计数<200个/μL组相比,CD4计数≥350个/μL组(HR=0.329,95%CI:0.186～0.582)和200～349个/μL组(HR=0.352,95%CI:0.186～0.668)死亡风险较低;抗病毒治疗组死亡风险低于未...     

湖北省2006—2015年接受艾滋病HAART患者生存时间及影响因素

目的探讨湖北省艾滋病高效抗逆转录病毒治疗(HAART)患者接受治疗后的生存状况,并研究影响生存时间的因素。方法回顾性分析湖北省开始接受HAART时间在2006年1月1日—2015年12月31日的艾滋病患者,年龄≥15岁,有完整的基线及随访信息。通过寿命表法计算患者的生存率、死亡率、累积生存率;通过Log-Rank检验比较不同组别间的生存时间差异并做单因素分析,采用Cox比例风险模型分析接受HAART后患者的生存时间影响因素。结果共计10 065例,其中男性7 449例(74.01%),女性2 616例(25.99%)。在观察期内有1 048例(10.41%)患者死亡,因艾滋病相关疾病死亡的有646例(61.64%),治疗开始后6个月内死亡的有471例(72.91%),治疗第1年死亡的有497例(76.93%);累积生存率从第1年的95.03%下降到第10年的86.97%;家政及服务业(HR=1.33,95%CI=1.09~1.62)死亡风险大,高中/中专(HR=3.26,95%CI=1.72~6.18)的死亡风险较初中及以下大。基线机会性感染数越多(≥3个HR=0.73,95%CI=0.58~0.93)、WHO临床分期越高(HR=0.59,95%CI=0.49~0.70)、基线CD4+T淋巴细胞计数(≥351个/μL HR=5.83,95%CI=1.84~18.54)、开始治疗时年龄越大(≥50岁HR=0.70,95%CI=0.58~0.85)的艾滋病患者接受HAART后死亡风险大。结论湖北省2006—2015年接受艾滋病HAART的患者治疗后累积生存率较高;基线机会性感染数越多、WHO临床分期越高、基线CD4+T淋巴细胞计数越低、开始治疗时年龄越大者接受HAART后生存时间短。     

2018年邛崃市老年人低体重现状及相关因素

目的了解邛崃市老年人低体重流行现状及相关因素。方法参照社区居民卫生调查表设计问卷,于2018年8-10月采用多阶段分层整群随机抽样方法,对邛崃市24个乡镇/街道常住居民进行问卷调查和体格检查,收集调查对象的基本情况、生活行为习惯、健康状况以及身高、体重等相关指标。低体重的判断采用成人体重判定行业标准(WS/T 428-2013)。共计14 929名60岁及以上老年人纳入样本(男性7581人,女性7348人;60~69岁8121人,70~79岁5176人,80岁及以上1632人),并计算低体重率,采用非条件Logistic回归分析低体重的相关因素。结果邛崃市老年人低体重率为5.7%(851/14929),其中男性为5.4%(413/7581),女性为6.0%(438/7348)。多因素Logistic回归分析显示,女性(OR=1.365, 95%CI 1.147~1.624)、高龄(70~79岁:OR=1.652, 95%CI 1.402~1.948;≥80岁:OR=2.557, 95%CI 2.079~3.145)、无配偶(OR=1.196, 95%CI 1.008~1.420)、吸烟(现在吸烟:OR=1.247, 95%CI 1.018~1.528;已戒烟:OR=1.536, 95%CI 1.036~2.276)、每天运动量未达到6000步(OR=1.259, 95%CI 1.083~1.462)、未患高血压(OR=1.591, 95%CI 1.321~1.915)者的低体重发生风险较高。结论 2018年邛崃市老年人低体重发生较低,性别、年龄、婚姻状况、吸烟史、每天运动量、高血压患病是老年人低体重的相关因素。     

中老年人社会隔离与高血压发病关系的队列研究北大核心CSCD

目的探讨我国中老年人社会隔离与高血压发病之间的关系。方法本研究选取CHARLS项目中2011年≥45岁且未发生高血压的中老年人为研究对象,随访2013和2015年高血压发病情况。采用Cox比例风险回归模型分析社会隔离对高血压发病的影响,按性别、年龄、抑郁情况分亚组进一步分析。结果共纳入9443名中老年人,高血压发病率为13.2%,在控制年龄、性别、学历、吸烟、饮酒、抑郁等其他变量以后,处于社会隔离的中老年人高血压发病风险与非社会隔离的中老年人相比增加了15.3%(HR=1.153,95%CI:1.027~1.294)。男性中老年人群中,社会隔离组高血压发病风险是非社会隔离组的1.205倍(HR=1.205,95%CI:1.019~1.425),而女性中老年人的社会隔离与高血压发病风险无关联(HR=1.099,95%CI:0.936~1.290)。在60~74岁人群中,社会隔离组的高血压发病风险是非社会隔离组的1.201倍(HR=1.201,95%CI:1.003~1.438),而45~59岁和75岁及以上中老年人的社会隔离和高血压发病风险均无关联(HR=1.121,95%CI:0.953~1.319;HR=0.997,95%CI:0.651~1.527)。按抑郁情况分组,非抑郁人群中社会隔离组高血压发病风险是非社会隔离组的1.251倍(HR=1.251,95%CI:1.070~1.463),而存在抑郁中老年人的社会隔离与高血压发病无关联(HR=1.058,95%CI:0.892~1.254)。结论社会隔离是高血压发病的重要危险因素,这一发现有助于拓展人群中社会关系与高血压之间联系的认识,为高血压防治提供新的思路。     

高发慢性病对老年人全因死亡影响的前瞻性研究

目的研究老年人群中6种常见慢性病及其共患情况对全因死亡的影响,为制定健康老龄化慢病防控策略提供科学依据。方法利用中国老年健康影响因素追踪调查(CLHLS)数据,CLHLS在2011年对7 080名65岁及以上人群进行基线调查,2014年随访一次,问卷内容包括调查对象人口统计学信息、生活方式与行为、慢性病相关信息。采用Stata 15.0进行t检验、χ~2检验。采用Cox比例风险模型分析6种常见慢性病及高发慢性病综合评分与老年人全因死亡的风险关联。结果 2014年随访时有2 121人死亡,死亡率为30.0%。多因素调整后,老年人患痴呆、癌症、糖尿病、肺部疾病、心血管疾病和高血压分别使全因死亡增加了113%(HR=2.13,95%CI:1.66～2.74),105%(HR=2.05,95%CI:1.39～3.03),59%(HR=1.59,95%CI:1.26～2.02),28%(HR=1.28,95%CI:1.12～1.45),13%(HR=1.13,95%CI:1.01～1.27),9%(HR=1.09,95%CI:1.01～1.19)。高发慢性病综合评分每增加1分,老年人群全因死亡风险增加46%(HR=1.46,95%CI:1.36～1.58)。高发慢性病综合评分为0.1～1.0、1.1～2.0、2.1～3.0、3.1～4.0和4.1～5.0分的老年人群慢性病死亡风险显著增加,危害比随着评分增加而呈增长趋势(HR值分别为1.17、1.72、2.41、4.63和11.65,P0.01)。结论高血压、糖尿病、心血管疾病、肺部疾病、痴呆和癌症是老年人全因死亡的独立危险因素,而高发慢性病共患对死亡风险呈增长趋势。控制慢性病相关危险因素,预防慢性疾病的发生和发展,对提高老年人群期望寿命有着重要意义。     

中国9个长寿地区65岁及以上人群血氧饱和度对死亡风险的影响

目的探讨65岁及以上人群血氧饱和度(S_pO₂)与3年全死因死亡风险的关系。方法研究对象来自2012-2014年在我国9个长寿地区开展的“老年健康生物标志物队列研究”,基于前瞻性队列研究,将2287名65岁及以上老年人群纳入研究。在2012年基线时收集调查对象SpO2、身体测量指标等数据,2014年随访时收集生存结局和死亡时间等数据。根据调查对象SpO2是否异常(SpO2<94%定义为异常)将其分为2组,采用Cox比例风险回归模型分析SpO2对死亡风险的影响。结果2287名研究对象年龄为(86.5±12.2)岁,男性1006名(44.0%);SpO2异常者315例(13.8%)。2014年随访时,452例死亡,1434例存活,401例失访,全死因死亡率为19.8%,随访率为82.5%。调整相关混杂因素后,与SpO2正常组相比,异常组死亡风险升高,HR(95%CI)为1.62(1.31~2.02);其中异常组男性死亡风险HR(95%CI)为1.49(0.98~2.26),女性为1.71(1.30~2.26);65~79、80~89、90岁及以上人群死亡风险HR(95%CI)分别为2.70(0.98~7.44)、1.22(0.63~2.38)、1.72(1.35~2.19)。结论SpO2异常可增加我国长寿地区老年人3年死亡风险。     

2型糖尿病患者血糖控制与全因死亡风险的相关性分析

目的 探讨2型糖尿病患者血糖控制与全因死亡风险的关联。方法 以淮安市清河区（现清江浦区）、淮安区纳入国家基本公共卫生服务管理的9 753例2型糖尿病患者作为观察队列,利用Cox回归和限制性立方样条分析血糖控制与2型糖尿病患者的全因死亡风险关联及剂量-反应关系,并进一步按性别分层分析。随访时长的计算从基线调查开始至2020年12月31日为止。结果 9 753例2型糖尿病患者随访期内死亡密度为20.4/1 000人年。与控制达标者相比,空腹血糖（fasting plasma glucose,FPG）控制未达标者的全死因风险增加36%（HR=1.36,95%CI:1.17~1.59）,糖化血红蛋白（glycated hemoglobin,HbA1c）控制未达标者的全死因风险增加65%（HR=1.65,95%CI:1.42~1.92）;与FPG 和HbA1c控制良好者相比,控制一般者、控制较差者的全死因风险分别增加47%（HR=1.47,95%CI:1.19~1.81）、75%（HR=1.75,95%CI:1.46~2.09）。限制性立方样条模型显示,FPG、HbA1c连续变化均与糖尿病患者全死因风险呈线性剂量-反应关系（P总趋势<0.001,P非线性>0.05）。按性别分层后,结论依然成立,且女性患者死亡风险高于相同血糖水平下的男性患者。结论 血糖控制不良会增加2型糖尿病患者的全因死亡风险,且女性死亡风险高于相同血糖水平下的男性。     

基于选择、优化和补偿模型理论的城乡老年人成功老龄化与健康坚韧性的关系研究

目的 调查城乡老年人成功老龄化与健康坚韧性和选择、优化、补偿（the selection,optimization,and compensation,SOC）之间的关系,为社区保健人员促进城乡老年人成功老龄化提供参考。方法 采用一般资料问卷、成功老龄化量表、健康坚韧性量表、SOC问卷,于2021年3—6月抽取承德市391名老年人进行问卷调查。使用结构方程模型并通过Bootstrap方法对SOC在健康坚韧性对成功老龄化的中介作用进行分析和验证。结果 老年人成功老龄化得分为（49.37±14.01）分,健康坚韧性得分为（139.84±24.33）分,SOC得分为（8.00±3.12）分,成功老龄化与健康坚韧性、SOC呈正相关（r = 0.128～0.992,P = 0.028）,健康坚韧性直接影响成功老龄化,而且,还通过SOC间接影响成功老龄化（P = 0.015）。结论 城乡老年人的健康坚韧性和SOC是成功老龄化的影响因素,并且SOC在健康坚韧性对成功老龄化之间存在中介效应。     

Successful aging: measuring the years lived with functional loss

Current research of risk factors potentially associated with successful aging faces the difficulty of taking into consideration two distinct outcome measures: survival and functioning. Previous studies either used successful aging measures restricted to survivors or presented more than one outcome measure to handle the dual outcome. This article illustrates the utility of health expectancy measures, based on life tables, to integrate the effects of survival and functioning across all ages. It is shown that three hypothetical successful aging strategies, considered equally successful according to the traditional measures restricted to survivors, are associated with vastly different changes in the years lived with and without disability. Furthermore, the intervention considered most successful when considering multiple successful aging measures, was associated with the largest increase in the time lived with disability. It is recommended that research on successful aging should be based on summary measures of population health that reflect both survival and functioning throughout life. These will provide more relevant information than is currently available for individuals and societies to evaluate and choose between successful aging strategies.     

社会隔离在社区老年人自我感知老化和成功老龄化之间的中介效应

目的 探讨社会隔离在社区老年人自我感知老化与成功老龄化之间的中介效应。方法 采取简版自我感知老化量表(B - APQ)、社会网络量表(LSNS - 6)、成功老龄量表(SAI)对628名社区老年人进行问卷调查。结果 社会隔离在自我感知老化和成功老龄化之间起部分中介作用,自我感知老化对成功老龄化的直接效应为 - 0.421,95%CI( - 0.166, - 0.468);通过社会隔离对其的间接效应为 - 0.281,95%CI( - 0.301, - 0.102),中介效应占总效应的40.03%。结论 老年人对自身积极的老化态度能直接促进成功老龄化,又可通过提高老年人的社会参与,减少社会隔离间接促进其成功老龄化。因此,社区工作者需给予老年人老化态度与社会隔离足够的重视,以期提高老年人晚年的生活质量,最终实现成功老龄化。     

Is car use related with successful aging of older adults? Results from the multinational Mediterranean islands study

PurposeThe aim of the present work was to evaluate the relation between car use and the level of successful aging of a random sample of older adults living in the Mediterranean basin.MethodsDuring 2005–2011, 2749 older (aged 65–100 years) from 22 islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the Mediterranean islands cross-sectional study. Sociodemographics, medical conditions, and dietary and lifestyle habits were derived throughout standard procedures. Car use was recorded with a standard binary question. A successful aging index ranging from 0–10 was used.ResultsOlder adults who used a car on regular basis had significantly higher levels of successful aging, as well as less prevalence of obesity and hypertension while were more physically active (P < .001). After adjusting for several confounders car use was still positively related with elderly islander's successful aging level (beta coefficient [95% confidence interval]: 0.65 [0.54–0.77]).ConclusionsIn conclusion, the activity of car use seems to be an indicator of quality of life among older adults, as measured through successful aging.     

Final Conversations: Helping the Living and the Dying Talk to Each Other

Social theories of successful aging attempt to explain how individuals adapt to changes characteristically associated with aging and to predict whether older adults' adaptations will lead to successful aging. The death of a spouse and the accompanying bereavement process entail dramatic changes to personal networks and experience to which individuals must adapt to age successfully. Network text analysis (including word frequencies, cluster analysis, and multidimensional scaling) of advice for adjusting to, and coping with, the loss of a spouse given by a sample of 60 bereaved spouses (mean age = 68) at 6 points in time after the death of their marital partner (3-4 weeks to 24 months) reveal respondents' lay theories of successful aging. Thematic clusters address social positioning and qualifiers, activity, communication, time, and spousal characteristics. Results indicate respondents frame their advice as unique to their context of social relationships while providing support for activity theory and negatively addressing disengagement theory.     

Lay theories of successful aging after the death of a spouse: a network text analysis of bereavement advice

Social theories of successful aging attempt to explain how individuals adapt to changes characteristically associated with aging and to predict whether older adults' adaptations will lead to successful aging. The death of a spouse and the accompanying bereavement process entail dramatic changes to personal networks and experience to which individuals must adapt to age successfully. Network text analysis (including word frequencies, cluster analysis, and multidimensional scaling) of advice for adjusting to, and coping with, the loss of a spouse given by a sample of 60 bereaved spouses (mean age = 68) at 6 points in time after the death of their marital partner (3-4 weeks to 24 months) reveal respondents' lay theories of successful aging. Thematic clusters address social positioning and qualifiers, activity, communication, time, and spousal characteristics. Results indicate respondents frame their advice as unique to their context of social relationships while providing support for activity theory and negatively addressing disengagement theory.     

Tracing the origins of successful aging: the role of childhood conditions and social inequality in explaining later life health

This study investigates the role of childhood conditions and social inequality in older Europeans' propensity to age successfully, controlling for later life risk factors. Successful aging was assessed following Rowe and Kahn's conceptualization, using baseline interviews from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). These data were merged with retrospective information on participants from 13 Continental European countries, collected as part of the SHARELIFE project. Our sample consists of 22,464 men and women, who are representative of the non-institutionalized population aged 50 or older (mean age: 63.3) in their respective country. Estimating multilevel logistic models, we controlled for demographics (age, sex), childhood conditions (SES, health, cognition), later life risk factors (various dimensions of SES and health behaviors), as well as social inequality (measured by country-specific Gini coefficients). There is an independent association of childhood living conditions with elders' odds of aging well. Higher parental SES, better math and reading skills, as well as self-reports of good childhood health were positively associated with successful aging, even if contemporary characteristics were controlled for. Later life SES and health behaviors exhibited the expected correlations with our dependent variable. Moreover, lower levels of income inequality were associated with a greater probability of meeting Rowe and Kahn's successful aging criteria. We conclude that unfavorable childhood conditions exhibit a harmful influence on individuals' chances to age well across all European welfare states considered in this study. Policy interventions should thus aim at improving the conditions for successful aging throughout the entire life course.     

Successful Aging and Mortality Risk: The Korean Longitudinal Study of Aging (2006-2014)

ObjectivesThe aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks.DesignRetrospective cohort study.Setting and participantsA total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data.MeasuresSuccessful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview.ResultsIn both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females.Conclusion/ImplicationWe found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.     

Nutrition and successful aging: a study of 520 elderly persons from the Toulouse and New-Mexico Aging Process Study

Epidemiological studies of aging are usually confronted with the presence of numerous pathologies or environmental factors which make it difficult to identify the effects of aging individually. One way of reducing the variability among individuals is to use well defined criteria to select the study population. This is the choice that was made for the New Mexico and Toulouse Aging Process Studies, which were particularly turned towards successful aging. In this study we have sought to explain the diversity of states of health of the subjects of these two studies by means of an aging classification exploring the medical history, balance and walking, and the cognitive functions. This reveals that the poorer health of certain subjects (about 10% and 30% of the populations of Toulouse and Albuquerque respectively) is slightly associated with changes in eating behaviour relative to subjects who age successfully. We have, however observed a decrease in vitamin E intake in Toulouse associated with a reduction of lipids in the food. But the poorer state of health is predominantly explained by advancing age and the occurrence of pathological states. This study confirms that aging was generally successful in the two populations studied.