ADL/IADL 残疾与多种疾病之间双向关联的纵向随访研究：来自两个中年和老年成年人全国样本队列的结果。

Longitudinal Follow-Up Studies on the Bidirectional Association between ADL/IADL Disability and Multimorbidity: Results from Two National Sample Cohorts of Middle-Aged and Elderly Adults.

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.

Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China.

出版信息

Gerontology. 2021;67(5):563-571. doi: 10.1159/000513930. Epub 2021 Jun 28.

DOI:10.1159/000513930

PMID:34182559

Abstract

BACKGROUND AND OBJECTIVES

Few studies have investigated the bidirectional relationship between disability and multimorbidity, which are common conditions among the older population. Based on the data from the China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Ageing and Retirement in Europe (SHARE), we aimed to investigate the bidirectional relationship between disability and multimorbidity.

METHODS

The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure disability. In stage I, we used multinomial logistic regression to assess the longitudinal association between ADL/IADL disability and follow-up multimorbidity. In stage II, binary logistic regression was used to evaluate the multimorbidity effect on future disability.

RESULTS

Compared with those free of disability, people with disability possessed ascending risks for developing an increasing number of diseases. For ADL disability, the odds ratio (OR) (95% confidence interval [CI]) values of developing ≥4 diseases were 4.10 (2.58, 6.51) and 6.59 (4.54, 9.56) in CHARLS and SHARE; for IADL disability, the OR (95% CI) values were 2.55 (1.69, 3.84) and 4.85 (3.51, 6.70) in CHARLS and SHARE. Meanwhile, the number of diseases at baseline was associated, in a dose-response manner, with future disability. Compared with those without chronic diseases, participants carrying ≥4 diseases had OR (95% CI) values of 4.82 (3.73, 6.21)/4.66 (3.65, 5.95) in CHARLS and 3.19 (2.59, 3.94)/3.28 (2.71, 3.98) in SHARE for developing ADL/IADL disability.

CONCLUSION

The consistent findings across 2 national longitudinal studies supported a strong bidirectional association between disability and multimorbidity among middle-aged and elderly adults. Thus, tailored interventions should be taken to prevent the mutual development of disability and multimorbidity.

摘要

背景与目的

残疾和多种疾病是老年人中常见的状况，但很少有研究调查这两者之间的双向关系。基于中国健康与养老追踪调查（CHARLS）和欧洲健康、衰老和退休纵向研究（SHARE）的数据，我们旨在调查残疾和多种疾病之间的双向关系。

方法

采用日常生活活动（ADL）和工具性日常生活活动（IADL）量表来衡量残疾。在第一阶段，我们使用多分类逻辑回归来评估 ADL/IADL 残疾与随访多种疾病之间的纵向关联。在第二阶段，使用二项逻辑回归来评估多种疾病对未来残疾的影响。

结果

与无残疾者相比，有残疾者发生疾病数量增加的风险逐渐升高。对于 ADL 残疾，CHARLS 和 SHARE 中发展≥4 种疾病的优势比（OR）（95%置信区间[CI]）值分别为 4.10（2.58，6.51）和 6.59（4.54，9.56）；对于 IADL 残疾，OR（95%CI）值分别为 2.55（1.69，3.84）和 4.85（3.51，6.70）。同时，基线时的疾病数量与未来残疾呈剂量-反应关系。与无慢性病者相比，患有≥4 种疾病的参与者发生 ADL/IADL 残疾的 OR（95%CI）值分别为 CHARLS 中的 4.82（3.73，6.21）/4.66（3.65，5.95）和 SHARE 中的 3.19（2.59，3.94）/3.28（2.71，3.98）。