婚姻伴侣关系质量与中老年人多重慢性病累积速率关系的ELSA数据库分析^*

Association Between Marital/Partner Relationship Quality and Accumulation Rate of Multiple Chronic Conditions in Middle-Aged and Older Adults: An Analysis Based on Data From English Longitudinal Study of Ageing

摘要

目的 探讨婚姻/伴侣关系质量与中老年人多重慢性病累积速率的关联。方法 基于英国老龄化纵向研究（English Longitudinal Study of Ageing，ELSA）第4～11轮调查数据，采用多重插补链式方程填补协变量缺失值，拟合线性混合模型分析婚姻/伴侣关系质量类型与慢性病累积速率的关系，并按性别、年龄分层探究效应的异质性。结果 共纳入7 943名研究对象。相较于支持型（高支持-低压力）婚姻/伴侣关系，其余关系类型及无伴侣状态均与更快的慢性病累积速率相关。其中，无伴侣者累积速度最快（β=0.042，95%CI：0.033～0.051），冷漠型（低支持-低压力）和厌恶型（低支持-高压力）次之（β=0.029，95%CI：0.007～0.051；β=0.027，95%CI：0.013～0.041），矛盾型（高支持-高压力）效应相对较弱（β=0.018，95%CI：0.009～0.026）。女性对该效应更为敏感。结论 不良婚姻/伴侣关系（矛盾型、冷漠型、厌恶型）及无伴侣状态均与中老年人慢性病累积速率加快相关，应优先关注女性人群。

Abstract

Objective To investigate the association between marital/partner relationship quality and the accumulation rate of multiple chronic conditions in middle-aged and older adults. Methods This study was based on the data from waves 4 to 11 of the English Longitudinal Study of Ageing (ELSA). Multiple imputation by chained equations was used to handle missing covariates. Linear mixed-effects models were fitted to examine the association between marital/partner relationship quality types and the accumulation rate of multiple chronic conditions. Effect heterogeneity was further explored through stratified analyses by sex and age. Results A total of 7 943 participants were included. Compared with individuals in supportive marital/partner relationships (with high support and low strain), all other relationship types and having no partner were associated with faster rates of accumulation of chronic diseases. Individuals with no partners showed the fastest accumulation rate (β = 0.042, 95% CI: 0.033-0.051), followed by those in indifferent relationships (with low support and low strain) and aversive relationships (with low support and high strain) (β = 0.029, 95% CI: 0.007-0.051; β = 0.027, 95% CI: 0.013-0.041). Those in ambivalent relationships (with high support and high strain) showed a relatively weaker effect (β = 0.018, 95% CI: 0.009-0.026). Women were more sensitive to this effect. Conclusion Adverse marital/partner relationships (including ambivalent, indifferent, and aversive) and the absence of a partner are associated with an accelerated accumulation rate of multiple chronic diseases in middle-aged and older adults, and priority attention should be given to the female population.

关键词

多重慢性病 / 婚姻质量 / 伴侣关系 / 中老年人

Key words

Multiple chronic conditions / Marital relationship quality / Partner relationship / Middle-aged and older adults

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基金资助

*国家自然科学基金面上项目(82574204)