中国中老年居民教育程度与失能发生:社会参与的中介作用

doi:10.19723/j.issn.1671-167X.2021.03.018

摘要/Abstract

摘要：

目的: 探究中老年人群教育程度与失能发生的关系及社会参与的中介作用。方法: 样本来源于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)2015年和2018年的追踪数据。教育程度、社会参与及其他变量采用2015年数据进行测量,失能则来源于2018年数据。采用卡方检验比较未受过教育(文盲)和受过教育(非文盲)组的个人特征和社会参与情况,采用Logistic回归分析教育程度及社会参与和失能发生之间的关系,并利用中介效应分析验证社会参与的中介作用。结果: 共纳入11 359名45岁及以上的中老年人,其中3 222人为文盲,文盲与非文盲人群失能的发生率分别为10.4%和6.2%。调查对象的社会参与度较低,仅为50%。在8项社交活动中,跟朋友交往(34.1%)比例最高,参加培训课程(0.6%)比例最低,文盲人群参与各项社交活动的比例均低于非文盲人群(P值均小于0.001)。与非文盲人群相比,文盲者失能发生的风险较高,调整后的比值比(adjusted odds ratio,aOR)为1.22(95%CI:1.02~1.45),且社会参与与失能的发生呈显著负相关(aOR=0.73,95%CI:0.63~0.85)。中介效应分析表明,社会参与可部分解释低教育程度对失能发生的不良影响,解释程度为12.22%。结论: 积极参与社交活动可缓解低教育水平对失能发生的不良影响,应鼓励中老年人,尤其是低教育水平的中老年人积极参与社交活动,可在一定程度上预防失能的发生。

关键词: 教育程度, 社会参与, 日常生活活动, 老年人, 健康状况

Abstract:

Objective: To investigate the association between educational attainment and the onset of disability in activities of daily living (ADL), and to explore the mediating effect of social participation on such association. Methods: A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2015 to 2018). The measurements of educational attainment, social participation and other covariates were identified from 2015, while the outcome measurement of ADL disability was constructed with data from survey 2018. Descriptive analyses were conducted, and basic characteristics and social engagement of the respondents were compared between illiterates and non-illite-rates using Chi-square test. Logistic regression was used to investigate the associations of educational attainment and social participation on the onset of ADL disability. Mediation analysis was employed to examine the mediator role of the social participation on the linkage from being illiterate to the ADL disability onset. Results: A total of 11 359 adults aged 45 years and above were included in the sample, of whom 3 222 were illiterates. The incidence of the onset of ADL disability of illiterates and non-illiterates were 10.4% and 6.2%, respectively. Among these respondents, only half of them were involved in social activities. Of all the 8 social activities, the percentage of interacting with friends (34.1%) was the highest, and the lowest percentage was observed in participating in an educational or training course (0.6%). Moreover, the percentages of participation in all these 8 social activities among illiterates were significantly lower than that of their educated counterparts (all P<0.001). The illiterate middle-aged and older adults were less likely to develop ADL disability in the follow-up period [adjusted odds ratio (aOR)=1.22, 95%CI: 1.02-1.45], and social participation was significantly associated with ADL disability onset (aOR=0.73, 95%CI: 0.63-0.85). Findings from mediation analysis illustrated that social participation accounted for 12.22% of the adverse effect of being illiterate on ADL disability onset. Conclusion: Social participation could buffer the negative effect of being illiterate on ADL disability onset in middle-aged and older adults, suggesting that engagement in social activities might have impact on prevention of impairments in physical function, especially for middle-aged and older illiterates.

Key words: Educational status, Social participation, Activities of daily living, Aged, Health status

中图分类号:

R195

彭顺壮, 付茜茜, 冯星淋. 中国中老年居民教育程度与失能发生:社会参与的中介作用[J]. 北京大学学报（医学版）, 2021, 53(3): 549-554.

PENG Shun-zhuang, FU Xi-xi, FENG Xing-lin. Association between education and the onset of disability in activities of daily living in middle-aged and older Chinese adults: The mediator role of social participation[J]. Journal of Peking University (Health Sciences), 2021, 53(3): 549-554.

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Characteristics	Overall, n (%) (n=11 359)	Illiterate, n (%) (n=3 222)	Non-illiterate, n (%) (n=8 137)	χ²	P value
Female	6 597 (58.1)	2 567 (79.7)	4 030 (49.5)	861.39	<0.001
Han	10 460 (92.1)	2 905 (90.2)	7 555 (92.8)	22.85	<0.001
Rural	7 174 (63.2)	2 444 (75.9)	4 730 (58.1)	311.60	<0.001
Age group/years				698.95	<0.001
45-	3 466 (30.5)	510 (15.8)	2 956 (36.3)
55-	3 881 (34.2)	1 185 (36.8)	2 696 (33.1)
65-	2 855 (25.1)	910 (28.2)	1 945 (23.9)
75-	1 157 (10.2)	617 (19.1)	540 (6.6)
Marital status				310.13	<0.001
Married/partnered	9 812 (86.4)	2 493 (77.4)	7 319 (89.9)
Others	1 547 (13.6)	729 (22.6)	818 (10.1)
Insurance				345.98	<0.001
UEBMI	1 283 (11.3)	97 (3.0)	1 186 (14.6)
URBMI/NRCMS	9 670 (85.1)	3 041 (94.4)	6 629 (81.5)
Other insurances	262 (2.3)	37 (1.1)	225 (2.8)
Without insurance	144 (1.3)	47 (1.5)	97 (1.2)
Economic status				390.26	<0.001
Poorest	2 422 (21.3)	1 032 (32.0)	1 390 (17.1)
Poor	2 493 (21.9)	757 (23.5)	1 736 (21.3)
Average	2 301 (20.3)	592 (18.4)	1 709 (21.0)
Rich	2 217 (19.5)	475 (14.7)	1 742 (21.4)
Richest	1 926 (17.0)	366 (11.4)	1 560 (19.2)
Smoke	696 (6.1)	84 (2.6)	612 (7.5)	96.90	<0.001
Drink	4 587 (40.4)	932 (28.9)	3 655 (44.9)	245.19	<0.001
Numbers of conditions				30.62	<0.001
0	4 887 (43.0)	1 277 (39.6)	3 610 (44.4)
1	3 166 (27.9)	1 007 (31.3)	2 159 (26.5)
2	1 949 (17.2)	558 (17.3)	1 391 (17.1)
3 and above	1 357 (11.9)	380 (11.8)	977 (12.0)
ADL disability onset^*	837 (7.4)	334 (10.4)	503 (6.2)	59.21	<0.001

Items	Overall, n (%) (n=11 359)	Illiterate, n (%) (n=3 222)	Non-illiterate, n (%) (n=8 137)	χ²	P value
Social participation	5 678 (50.0)	1 304 (40.5)	4 374 (53.8)	162.89	<0.001
Interacted with friends	3 877 (34.1)	957 (29.7)	2 920 (35.9)	39.25	<0.001
Played mahjong, chess and cards, or went to community club	2 061 (18.1)	287 (8.9)	1 774 (21.8)	258.37	<0.001
Provided help to family, friends, or neighbors who did not live with you or pay you for help	1 677 (14.8)	356 (11.0)	1 321 (16.2)	49.32	<0.001
A sport, social, or other kind of club	837 (7.4)	120 (3.7)	717 (8.8)	87.51	<0.001
A community-related organization	245 (2.2)	23 (0.7)	222 (2.7)	44.38	<0.001
Done voluntary or charity work	153 (1.3)	12 (0.4)	141 (1.7)	32.14	<0.001
Cared for a sick or disabled adult who did not live with you or pay you for help	349 (3.1)	63 (2.0)	286 (3.5)	18.85	<0.001
An educational or training course	69 (0.6)	2 (0.1)	67 (0.8)	22.16	<0.001

Variables	Unadjusted model			Adjusted model
Variables	OR	95%CI	P value	aOR	95%CI	P value
Illiterate
Yes	1.75	1.52-2.03	<0.001	1.22	1.02-1.45	0.026
No	Reference			Reference
Social participation
Yes	0.66	0.57-0.76	<0.001	0.73	0.63-0.85	<0.001
No	Reference			Reference

Effect	Unadjusted model				Adjusted model
Effect	β	95%CI	P value	Mediated	β	95%CI	P value	Mediated
Total effect	0.565	0.420-0.710	<0.001		0.232	0.066-0.398	0.006
Direct effect	0.517	0.371-0.663	<0.001	8.36%	0.203	0.037-0.370	0.017	12.22%
Indirect effect	0.047	0.027-0.068	<0.001		0.028	0.013-0.044	<0.001