李丹1，2，郑华涛1，2，马仁涛1，2，杨鄂1，2，赖雨1，2，罗丹1，2，王世强1，2
(1.湖南工业大学 体育学院，湖南 株洲 412006；2.体质健康和运动健身湖南省重点实验室，湖南 株洲 412006)
摘 要：基于2011—2020年中国健康与养老追踪调查(CHARLS)5期数据，采用组基轨迹模型识别调查对象随访期间身体活动随时间变化的潜在分组和轨迹特征，并采用Bootstrap法检验模型稳定性，采用多因素Logistic回归模型分析不同身体活动轨迹类型与慢性病共病的关联。通过亚组分析探究不同特征老年人在不同身体活动变化轨迹下的共病差异，并通过Bonferroni多重校正进行多重比较。结果显示：纳入3 182名老年人，共识别出4种身体活动轨迹，分别为身体活动持续低组(693人，占21.78%)、先低后上升组(1 651人，占51.89%)、先高后下降组(225人，占7.07%)及持续高身体活动组(613人，占19.26%)，4组间慢性病共病发生率比较，差异具有统计学意义(
=36.036，P<0.01)。调整混杂因素后，以身体活动持续低组为参照，先低后上升组和持续高组发生慢性病共病的风险显著降低，OR值(95%CI)分别为0.673(0.558~0.813)、0.613(0.484~0.777)。身体活动先低后上升组和持续高组老年人患二元共病的风险也显著降低，分别是持续低组的0.758倍(95%CI：0.581~0.990)和0.627倍(95%CI：0.445~0.884)，三元及以上共病风险分别是身体活动持续低组的0.625倍(95%CI：0.501~0.780)和0.607倍(95%CI：0.459~0.801)。与身体活动持续低组相比，身体活动先高后降低组和持续高组对慢性病共病的风险均无明显差异。亚组分析显示，先低后上升组和持续高身体活动组在年龄≥65岁、男性、居住在城镇的老年人中，与慢性病共病风险的关联更为显著。研究认为，中国老年人身体活动存在不同轨迹类型，不同轨迹与老年慢性病共病风险存在差异，先低后上升和持续高身体活动轨迹具有较低的慢性病共病发生风险。
关 键 词：老年人；身体活动；组基轨迹；慢性病共病
中图分类号：G804.5 文献标志码：A 文章编号：1006-7116(2025)05-0144-09
Association between physical activity change trajectory and
comorbidity of chronic diseases in Chinese older people:
An empirical study based on the CHARLS data
LI Dan1, 2，ZHENG Huatao1, 2，MA Rentao1, 2，YANG E1, 2，LAI Yu1, 2，LUO Dan1, 2，WANG Shiqiang1, 2
(1.School of Physical Education，Hunan University of Technology，Zhuzhou 412006，China；2.Hunan Provincial Key Laboratory of Physical Health and Sports Fitness，Zhuzhou 412006，China)
Abstract: Based on the data in five periods from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, group-based trajectory modeling was used to identify the potential grouping and trajectory characteristics of physical activity over time during the follow-up period, and the Bootstrap was also used to test stability of model, and multivariate logistic regression model was employed to examine the latent correlation between different types of physical activity trajectories and comorbidity of chronic diseases. Subgroup analyses were performed to examine comorbidity differences among older people with various characteristics across different physical activity trajectories, with multiple comparisons by adjusted using the Bonferroni correction. Results show that 3 182 older people was selected and the respondents' physical activity trajectories were categorized into four groups including continuous low physical activity (693 individuals, 21.78%), initially low then rising (1 651 individuals, 51.89%), initially high then declining (225 individuals, 7.07%), and continuous high physical activity (613 individuals, 19.26%), and there was a statistically significant difference in the incidence of chronic diseases among the four groups (χ2= 36.036, P<0.001). After adjusted with confounding factors, the multivariate logistic regression analysis revealed that compared to the continuous low physical activity group, the risk of chronic disease comorbidity was significantly lower in the initially low then rising group (OR = 0.673, 95% CI: 0.558~0.813) and the continuous high physical activity group (OR = 0.613, 95% CI: 0.484~0.777). The risk of binary comorbidity and ternary and above comorbidity was also significantly reduced in these two groups, with OR values (95% CI) of 0.758 (0.581~0.990), 0.627 (0.445~0.884), 0.625 (0.501~0.780), and 0.607 (0.459~0.801), respectively. Compared to continuous low physical activity group, in risk of comorbidity with chronic diseases, there was no significant difference in initially high then declining and continuous high group in physical activity. Subgroup analyses show that the risk of comorbidity with chronic diseases was more significantly reduced in the initially low then rising group and the continuous high physical activity group among individuals aged ≥ 65 years, males, those living in urban areas. The conclusion holds that physical activity of Chinese older people exhibits different types with trajectories, and there is significant difference between different trajectories and comorbidity risk of chronic diseases in older people, and meanwhile, the trajectory with initially low then rising and continuous high physical activity group show an inferior risk of trajectory with chronic diseases.
Keywords: older people；physical activity；group-based trajectory；comorbidity of chronic diseases