目的 探讨中国老年夫妻间慢性共病与衰弱水平的动态互倚关系,分析主体效应与客体效应的作用路径及性别差异.方法 基于2013-2015年“中国健康与养老追踪调查数据库”2362对夫妻的纵向数据,采用 Spearman相关分析探讨中国老年夫妻慢性共病与衰弱水平的相关性,并使用 AMOS软件建立主客体互倚交叉滞后模型,分析老年夫妻间慢性共病与衰弱水平的动态互倚关系.结果 主体效应中,夫妻基线慢性病均正向关联自身2年后衰弱水平(丈夫β=0．05,妻子β=0．04, 均P＜0．001);衰弱反馈慢性病存在性别差异,仅妻子衰弱预测自身新增共病(β=0．09,P=0．001).客体效应中,妻子基线衰弱水平与丈夫随访期衰弱水平有微弱的正向关联性(β=0．05,P=0．025),而丈夫衰弱对妻子未观测到关联性;慢性病的夫妻间跨个体影响均无统计学差异(均P＞0．05).结论 中国老年夫妻间的慢性共病与衰弱水平之间存在主体以及部分客体的交互影响作用,提示在老年健康管理实践中,除了关注个体层面的干预,也应引入“夫妻单元”的视角,发展协同管理策略.

Objective To explore the dynamic interdependence relationship between chronic multimorbidity and frailty among older Chinese couples，and to analyze the pathways of actor and partner effects as well as gender differences.Methods Based on longitudinal data from 2,362 couples in the China Health and Retirement Longitudinal Study (CHARLS) database from 2013 to 2015，Spearman correlation analysis was used to examine the correlation between chronic multimorbidity and frailty levels in older Chinese couples.A cross-lagged actor-partner interdependence model (APIM) was constructed using AMOS software to analyze the dynamic interdependent relationship between the 2 factors among such couples.Results In terms of actor effects，the baseline chronic multimorbidity of both husbands and wives was positively associated with their own frailty levels 2 years later (husband β=0.05，wife β=0.04，all P＜0.001).The feedback effect of frailty on chronic multimorbidity showed gender differences;only the wife’s frailty predicted her own new-onset multimorbidity (β=0.09，P=0.001).Regarding partner effects，the wife’s baseline frailty level had a weak positive association with the husband’s follow-up frailty level (β=0.05，P=0.025)，while no association was observed between the husband’s frailty and the wife’s frailty.No statistically significant cross-spousal effects of chronic multimorbidity were found (all P＞0.05).Conclusions There are interactive influences，including actor effects and some partner effects，between chronic multimorbidity and frailty levels among older Chinese couples.This suggests that in geriatric health management practices，in addition to focusing on individual-level intervention，the “couple as a unit” perspective should be introduced to develop collaborative management strategies.

R473.59

国家自然科学基金项目（72304210）；上海申康医院发展中心研究型医师创新转化能力培训项目（SHDC2023CRS024）