Department of Public Management, School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Hospital Management, School of Public Health, Fudan University, Shanghai, China.
J Gerontol A Biol Sci Med Sci. 2024 Apr 1;79(4). doi: 10.1093/gerona/glae040.
Air pollution is a frailty risk factor, yet the frailty-related health benefits of China's air pollution control policy, the Clean Air Action (CCAA), are unclear. Frailty progression and transitions differ among robust, prefrail, and frail adults. This study aimed to evaluate the CCAA's effect on frailty levels among robust, prefrail, and frail Chinese adults.
Using propensity score matching with difference-in-differences analysis, we studied 9 788 adults aged ≥45 from the 2011 and 2018 China Health and Retirement Longitudinal Study. The Frailty Index (FI), summarizing 32 health deficits, quantifies frailty level (range: 0-1 scores). Frailty was defined as FI ≥ 0.25, prefrailty as FI 0.10-0.25, and robust as FI ≤ 0.10. We examined frailty transitions between these states (robust, prefrail, and frail) from 2011 to 2018. Based on provincial particulate matter reduction targets, participants were assigned to intervention (>10% reduction) or control (≤10%) groups and categorized as robust, prefrail, or frail pre-CCAA implementation.
The CCAA significantly reduced FI scores among preimplementation robust individuals by 0.0205 and among prefrail individuals by 0.0114, with no significant changes in frail individuals. Frailty transition analyses confirmed specific benefits of the CCAA, which significantly reduced worsening from robust to prefrail or frail by 7.0% and prefrail to frail by 3.9%. However, it did not facilitate the improvement from frail to prefrail/robust or from prefrail back to robust. No significant subgroup differences were observed across age, gender, Hukou, education, and social participation.
CCAA has been associated with a reduction in frailty deterioration in robust and prefrail populations.
空气污染是脆弱性的一个风险因素，但中国空气污染控制政策（清洁空气行动，CCAA）对脆弱性相关健康的益处尚不清楚。虚弱的进展和转变在健康、虚弱前期和虚弱的成年人中有所不同。本研究旨在评估 CCAA 对中国健康、老龄化和纵向研究中 45 岁以上的健康成年人虚弱水平的影响。
采用倾向评分匹配的差分分析方法，对 2011 年和 2018 年中国健康与退休纵向研究中的 9788 名年龄≥45 岁的成年人进行了研究。虚弱指数（FI）总结了 32 种健康缺陷，量化了虚弱水平（范围：0-1 分）。将 FI≥0.25 定义为虚弱，FI 为 0.10-0.25 定义为虚弱前期，FI≤0.10 定义为健康。我们观察了 2011 年至 2018 年这些状态之间的虚弱转变（健康、虚弱前期和虚弱）。根据省级颗粒物减排目标，参与者被分配到干预（减排>10%）或对照组（≤10%），并在 CCAA 实施前被分类为健康、虚弱前期或虚弱。
CCAA 显著降低了实施前健康个体的 FI 评分 0.0205，虚弱前期个体的 FI 评分 0.0114，而虚弱个体的 FI 评分没有显著变化。虚弱过渡期分析证实了 CCAA 的具体益处，它显著降低了从健康到虚弱前期或虚弱的恶化率 7.0%，从虚弱前期到虚弱的恶化率 3.9%。然而，它并没有促进从虚弱到虚弱前期/健康或从虚弱前期恢复到健康。在年龄、性别、户口、教育和社会参与方面没有观察到显著的亚组差异。
CCAA 与健康和虚弱前期人群虚弱恶化的减少有关。
