健康老龄化指数及其与个体与邻里相对教育的关系：基于人群的队列研究。
Healthy aging index and its link with relative education between individual and neighborhood: a population-based, cohort study.
机构信息
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua West Road, Jinan, 250012, Shandong, China.
National Institute of Health Data Science of China, Shandong University, Jinan, 250012, Shandong, China.
出版信息
BMC Geriatr. 2022 Oct 3;22(1):778. doi: 10.1186/s12877-022-03469-7.
OBJECTIVES
There is increasing recognition of the importance of neighborhood socioeconomic status (SES) for establishing an age-friendly society. Despite the benefits of improved neighborhood SES, little is known about the link of relative education between individuals and neighborhoods with healthy aging. This study aims to construct a healthy aging index (HAI) accounting for indicators' interlinkages and to test the association of the HAI with relative education between neighborhoods and individuals.
METHODS
The study used data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including middle-aged and older adults (≥ 45 years). The final sample comprised 11633 participants residing in 443 neighborhoods with 34123 observations. Based on 13 health indicators, a hybrid method integrating network analysis with TOPSIS was applied to construct a HAI accounting for health interlinkages. Weighted multilevel linear and ordered logistic models were used to estimate the effects of neighborhood education.
RESULTS
Among the 11633 participants (mean [SD] age, 58.20 [8.91] years; 6415 women [52.82%]), the mean (SD) HAI was 48.94 (7.55) at baseline, showing a downward trend with age. Approximately 10% of participants had a HAI trajectory characterized by a low starting point and fast decline. A one-year increase in neighborhood education was independently associated with a 0.37-point increase (95% CI, 0.23-0.52) in HAI. Regardless of individual education, each participant tended to gain benefits from a neighborhood with higher education. However, the effects of increased neighborhood education were weaker for individuals whose education was lower than the neighborhood average.
CONCLUSIONS
The HAI is an interaction system. Improving neighborhood education was beneficial to healthy aging, but individuals with lower education relative to the neighborhood average may experience poor person-environment fit and obtain fewer benefits from improved neighborhood education. Thus, in the process of improving neighborhood SES, individual-based interventions should be conducted for individuals whose education level is lower than the neighborhood average to achieve person-environment fit.
目的
越来越多的人认识到邻里社会经济地位（SES）对于建立一个适合老年人居住的社会的重要性。尽管改善邻里 SES 有很多好处，但对于个体与邻里之间相对教育与健康老龄化之间的联系知之甚少。本研究旨在构建一个考虑指标相互关系的健康老龄化指数（HAI），并检验该指数与个体与邻里之间相对教育的关联。
方法
本研究使用了 2011 年至 2018 年中国健康与退休纵向研究的数据，包括中年和老年人（≥45 岁）。最终样本包括 11633 名居住在 443 个邻里的参与者，共 34123 个观察值。基于 13 个健康指标，采用网络分析与 TOPSIS 相结合的混合方法构建了一个考虑健康相互关系的 HAI。使用加权多层线性和有序逻辑模型来估计邻里教育的影响。
结果
在 11633 名参与者中（平均[标准差]年龄为 58.20[8.91]岁，6415 名女性[52.82%]），基线时的平均（标准差）HAI 为 48.94（7.55），随着年龄的增长呈下降趋势。约 10%的参与者具有低起点、快速下降的 HAI 轨迹。邻里教育增加一年与 HAI 增加 0.37 分（95%置信区间：0.23-0.52）独立相关。无论个体教育水平如何，每个参与者都倾向于从教育水平较高的邻里中获益。然而，对于教育水平低于邻里平均水平的个体，增加邻里教育的效果较弱。
结论
HAI 是一个相互作用的系统。提高邻里教育水平有利于健康老龄化，但相对于邻里平均水平教育水平较低的个体可能会经历较差的人与环境适配，从改善邻里教育中获得的益处较少。因此，在改善邻里 SES 的过程中，对于教育水平低于邻里平均水平的个体，应开展基于个体的干预措施，以实现人与环境的适配。
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