Relationship between socioeconomic status and restricted mobility trajectory in the life course of middle-aged and elderly people
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摘要:
目的 通过评估生命历程中社会经济状态与移动能力受限轨迹之间的关系，为确定中老年人群晚期生活质量的风险因素提供证据支持。 方法 基于中国健康与养老追踪调查数据，纳入第3次随访并至少观察到2次移动能力受限的7 714名受试者，采用基于群组的轨迹模型探索移动能力受限的最佳轨迹组别; 采用多项logistic回归模型评估每个随访者的社会经济状态、生命历程中社会经济状态(SES)轨迹与移动能力受限轨迹的关联。采用中介效应分析探究成年社会经济状态(ASE)在儿童期社会经济状态(CSE)与移动能力受限轨迹组别关联中的中介效应。 结果 通过对受试者的分析，参与者在童年或成年时期经历了低水平的社会经济地位，则有较高的风险发展为移动能力受限较差的轨迹组。与高-高SES相比，高-低SES和低-低SES均分别与持续性中等以及递增至高的移动能力受限轨迹风险增加有关，且这两个时期累积暴露于不良SES的风险最大。此外，ASE对CSE与持续中轨迹组或递增至高轨迹组之间的关联具有显著的间接影响，移动能力受限轨迹与CSE之间的相关性可达13.68%~35.90%。 结论 通过干预儿童期和成年期社会经济状态的暴露水平，可以有效降低晚年移动能力受限的发生风险。 Abstract:Objective To evaluate the association between socioeconomic status and the trajectory of mobility limitation over the life course, and to provide evidence to support the identification of risk factors for late quality of life in middle-aged and older adults. Methods Based on the China Health and Retirement Tracking Survey (CHARLS) data, into the third followed up and observed at least twice limited mobility of 7 714 subjects, the trajectory model based on group to explore mobile capacity constrained optimal trajectory group. Multinomial logistic regression models were used to assess the socioeconomic status of each follow-up and the association between socioeconomic status (SES) trajectories over the life course and mobility limitation trajectories. Mediating effect analysis was used to explore the mediating effect of adult socioeconomic status (ASE) on the association between childhood socioeconomic status (CSE) and the trajectory of mobility limitation. Results The participants with low SES in childhood or adulthood were at higher risk of developing into the poor mobility limitation trajectory group. Compared with high-high SES, high-low SES and low-low SES were both associated with an increased risk of persistent moderate and increasing to high mobility limitation trajectories, respectively, and the cumulative risk of exposure to adverse SES was greatest during these two periods. In addition, ASE had a significant indirect effect on the association between CSE and the persistent trajectory group or the increasing trajectory group, and the correlation between the mobility limitation trajectory and CSE could reach 13.68%-35.90%. Conclusion Intervention in socioeconomic status exposure in childhood and adulthood can effectively reduce the risk of mobility limitations in later life. -
图 1 CHARLS研究中第1次、第2次和第4次的移动能力受限得分轨迹
Figure 1. Trajectories of mobility limitations scores across waves 1, 2, and 4 in the CHARLS study
图 2 与社会经济状态有关的移动能力受限轨迹的关联
Figure 2. Association between mobility limitation trajectories and socioeconomic factors
图 3 3种社会经济状态与移动能力受限轨迹的相关性
注：A为生命历程SES轨迹; B为生命历程累积SES评分; C为经ASE修正的CSE。
Figure 3. Associations between three socioeconomic states and mobility limitation trajectories
表 1 与移动能力受限轨迹有关的研究样本特征
Table 1. Characteristics of the study sample in relation to mobility limitation trajectories
项目 总数(n=7 714) 移动能力受限组 统计量 P值 持续性低(n=5 470) 持续性中等(n=1 825) 递增至高(n=419) 年龄(x±s) 57.05±8.25 55.68±7.68 59.61±8.53 63.24±8.54 284.784a < 0.001 性别[例(%)] 男性 3 896(50.51) 3 069(56.11) 691(37.86) 136(32.46) 239.919b < 0.001 女性 3 818(49.49) 2 401(43.89) 1 134(62.14) 283(67.54) 与伴侣同居[例(%)] 是 6 716(87.06) 4 865(88.94) 1 503(82.36) 348(83.05) 58.975b < 0.001 否 998(12.94) 605(11.06) 322(17.64) 71(16.95) BMI[例(%)] 正常 4 275(55.53) 3 120(57.14) 962(52.74) 193(46.62) 47.453b < 0.001 体重过轻 447(5.81) 270(4.95) 137(7.51) 40(9.66) 超重 2 162(28.09) 1 530(28.02) 505(27.69) 127(30.68) 肥胖 814(10.57) 540(9.80) 220(12.06) 54(13.04) 吸烟状况[例(%)] 吸烟者 2 979(40.07) 2 255(43.99) 593(33.31) 131(32.03) 63.502b < 0.001 不吸烟者 4 455(59.93) 2 990(57.01) 1 187(66.69) 278(67.97) 饮酒量[例(%)] 饮酒者 4 787(62.07) 3 148(57.56) 1 331(72.97) 308(73.51) 162.715b < 0.001 不饮酒者 2 925(37.93) 2 321(42.44) 493(27.03) 111(26.49) 体育活动[例(%)] 是 2 970(93.63) 2 089(93.97) 730(93.95) 151(87.79) 10.406b 0.005 否 202(6.37) 134(6.00) 47(6.05) 21(12.21) 注：a为F值，b为χ2值。 
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表 2 变量及赋值情况
Table 2. Variable assignment
变量 赋值方法 一般人口学特征 性别 男性=0，女性=1 婚姻状况 未与伴侣同居=0，与伴侣同居=1 BMI 体重过轻=1，正常=2，超重=3，肥胖=4 吸烟状况 不吸烟者=0，吸烟者=1 饮酒状况 不饮酒者=0，饮酒者=1 体育活动 否=0，是=1 儿童社会经济状态 父亲职业 非农民=0，农民=1 母亲职业 非农民=0，农民=1 缺乏食物 否=0，是=1 经历逃荒 否=0，是=1 自述CSE水平 平均水平或更好=0，低于平均水平=1 成人社会经济状态 教育水平 较高(高中或以上)=0，较低(初中或以下)=1 自己职业 非农民=0，农民=1 自述ASE水平 平均水平或以上=0，低于平均水平=1 移动能力受限轨迹 持续性低轨迹组=1，持续性中等轨迹组=2，递增至高轨迹组=3
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表 3 儿童和成人社会经济状态与移动能力受限轨迹的关联
Table 3. Association between childhood socioeconomic status and adult socioeconomic status with mobility limitations trajectories
变量 持续性中等vs.持续性低 递增至高vs.持续性低 OR(95% CI) P值 OR(95% CI) P值 儿童社会经济状态 父亲职业为农民 1.85(1.32~2.61) < 0.001 1.70(0.89~3.23) 0.226 母亲职业为农民 1.55 (1.31~1.83) < 0.001 2.10(1.45~3.03) < 0.001 缺乏食物 1.47(1.30~1.67) < 0.001 1.53(1.20~1.95) 0.029 经历逃荒 1.31(1.09~2.50) 0.028 1.87(1.39~2.52) < 0.001 自述CSE低于平均水平 1.46(1.31~1.62) < 0.001 1.55(1.27~1.89) 0.024 成人社会经济状态 教育水平较低 2.48(2.05~2.99) < 0.001 2.52(1.73~3.65) < 0.001 自己职业为农民 2.57(2.26~2.91) < 0.001 4.40(3.29~5.88) < 0.001 自述ASE低于平均水平 1.47(1.32~1.63) < 0.001 1.69(1.38~2.07) < 0.001 注：在儿童社会经济状态中，父母职业以非农民为参照，缺乏食物、经历逃荒以否为参照，自述CSE水平以较高为参照; 在成人社会经济状态中，教育水平以较高为参照，自己职业以非农民为参照，自述ASE以平均水平或以上为参照。
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