我国中老年人群孤独感与重大慢病状态转换风险及健康预期寿命的关联研究

doi:10.3969/j.issn.1006-7795.2026.04.018

首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (4): 775-782.doi: 10.3969/j.issn.1006-7795.2026.04.018

我国中老年人群孤独感与重大慢病状态转换风险及健康预期寿命的关联研究

夏雪^1,2,3，田雪^1,2,3，周全^1,2,3，胥芹^1,2,3，张怡君^1,2,3，张晓丽^1,2,3，李静^1,2,3，王安心^1,2,3*

1.首都医科大学附属北京天坛医院北京市神经外科研究所流行病学研究室，北京 100070; 2.首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心，北京 100070; 3.首都医科大学临床流行病学与临床试验学系，北京 100070

收稿日期:2025-11-08 修回日期:2025-12-23 出版日期:2026-08-21 发布日期:2026-07-26
通讯作者: 王安心 E-mail:wanganxin@bjtth.org
基金资助:
国家自然科学基金资助项目（82504498）。

Association of loneliness with transition risks of major non-communicable chronic diseases and healthy life expectancy among middle-aged populations in China

Xia Xue^1,2,3， Tian Xue^1,2,3， Zhou Quan^1,2,3， Xu Qin^1,2,3， Zhang Yijun^1,2,3， Zhang Xiaoli^1,2,3， Li Jing^1,2,3， Wang Anxin^1,2,3*

1.Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 2.China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing 100070, China

Received:2025-11-08 Revised:2025-12-23 Online:2026-08-21 Published:2026-07-26
Supported by:
This study was supported by the National Natural Science Foundation of China (82504498).

摘要/Abstract

摘要： 目的索中老年人群中孤独感与重大慢病状态转换风险的关联，量化其对预期寿命及健康预期寿命的影响。方法基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）中≥45岁人群2011—2020年随访数据，拟合多状态Markov模型（multi-states Markov model，MSM）分析孤独感对中老年重大慢病发生发展的影响，并进一步利用微观仿真法量化其对于健康预期寿命及总预期寿命的影响。结果本研究合计纳入12 316例研究对象，47.99%为男性，中位年龄59(52,66）岁。重大慢病状态转换主要涉及由健康到重大慢病，由健康到死亡及由重大慢病到死亡3条路径。随访过程中共记录3 616例新发重大慢病，1 858例死亡。与很少感到孤独者相比，有孤独感的健康人重大慢病及死亡的风险分别增加20%（OR＝1.20，95%CI：1.10~1.30）和38%（OR＝1.38，95%CI：1.15~1.66）。不同性别人群中，孤独感均与由健康向重大慢病转移的风险存在显著关联，但其影响在由健康或重大慢病向死亡转移路径上可能存在性别异质性（P_交互<0.05）。此外，有孤独感的中老年人预期寿命更短，其中健康存活时间占比也更低。对初始状态健康人群而言，孤独者与非孤独者45岁时健康预期寿命及其占比分别为12.8岁（32.8%）与14.4岁（34.5%）。结论孤独感会显著增加中老年人群由健康向重大慢病或死亡状态的转化风险，在缩短预期寿命的同时，进一步压缩其中健康预期寿命的占比。

关键词: 孤独感, 慢性非传染性疾病, 多状态Markov模型, 预期寿命, 健康预期寿命, 队列

Abstract: Objective To explore the association between loneliness and the whole transition course of non-communicable chronic diseases (NCDs), and to quantify its impact on life expectancy (LE) and healthy life expectancy (HLE) among middle-aged population.Methods Based on the 2011—2020 follow-up data of individuals aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS), a multi-state Markov model (MSM) was fitted to analyze the association of loneliness with the occurrence and progression of NCDs. Further, microsimulation was used to quantify its impact on both LE and HLE.Results Of 12 316 participants included in the study, 47.99% were males and the median age was 59 （52，66） years-old. The transition course of NCDs mainly involved three pathways: from health to NCDs, from health to death, and from NCDs to death. During the follow-up period, 3 616 new cases of NCDs and 1 858 deaths were recorded. Compared with those who rarely felt lonely, healthy individuals with loneliness had a 20% increased risk of NCDs (OR＝1.20， 95%CI: 1.10－1.30) and a 38% increased risk of death (OR＝1.38， 95%CI: 1.15－1.66). Loneliness was significantly associated with an increased risk of transition from health to NCDs regardless of gender, whereas its impacts on transitions from health or NCDs to death seemed different between males and females (P _{forinteraction}< 0.05). In addition, middle-aged individuals with loneliness had shorter LE, and the proportion of healthy survival time was also smaller. For individuals who were initially healthy, the HLE at the age of 45 years and its proportion was 12.8 years (32.8%) for lonely participants and 14.4 years (34.5%) for those without loneliness, respectively.Conclusion Loneliness was significantly associated with increased risks of NCDs and death, which led to shortened LE and reduced proportion of HLE for middle-aged population.

Key words: loneliness, non-communicable chronic disease, multi-state Markov model, life expectancy, healthy life expectancy, cohort

中图分类号:

夏雪, 田雪, 周全, 胥芹, 张怡君, 张晓丽, 李静, 王安心. 我国中老年人群孤独感与重大慢病状态转换风险及健康预期寿命的关联研究[J]. 首都医科大学学报, 2026, 47(4): 775-782.

Xia Xue, Tian Xue, Zhou Quan, Xu Qin, Zhang Yijun, Zhang Xiaoli, Li Jing, Wang Anxin. Association of loneliness with transition risks of major non-communicable chronic diseases and healthy life expectancy among middle-aged populations in China[J]. Journal of Capital Medical University, 2026, 47(4): 775-782.

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我国中老年人群孤独感与重大慢病状态转换风险及健康预期寿命的关联研究

Association of loneliness with transition risks of major non-communicable chronic diseases and healthy life expectancy among middle-aged populations in China

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