社区环境对老年人衰弱的影响:健康不平等的中介作用和社会参与的调节作用OA
The Impact of Community Environment on Frailty among Older Adults from The Mediating Role of Health Inequal-ity and the Moderating Role of Social Participation
目的:探讨社区环境对老年人衰弱的影响,检验健康不平等在社区环境与衰弱之间的中介作用以及社会参与的调节作用.方法:基于中国健康与养老追踪调查(CHARLS)2011年社区调查数据和2018年个户追踪调查数据,共纳入研究对象7483名.获取社区环境、衰弱、健康不平等和社会参与和人口学资料等信息.使用SPSS Process宏程序检验健康不平等的中介作用以及社会参与的调节作用,并绘制简单斜率图.结果:社区环境负向预测老年人衰弱(β=-0.298,P＜0.001);健康不平等在社区环境与衰弱间起部分中介作用,中介效应(-0.0803)占总效应(-0.298)的26.95％;社会参与调节了健康不平等对衰弱影响的路径(β=-0.6178,P＜0.001),即调节了中介效应的后半段.简单斜率检验结果显示,低社会参与组中,健康不平等对衰弱的正向预测作用较强(β=9.1072,P＜0.001);高社会参与组中,该预测作用减弱(β=7.2537,P＜0.001).结论:社区环境和健康不平等是老年人衰弱的重要影响因素,健康不平等在社区环境与衰弱间起中介作用,社会参与在中介路径的后半段起调节作用.高社会参与能够削弱健康不平等对衰弱的负面影响.建议优先改造基础环境较差的社区缩小差距,重点关注出行安全性与公共活动空间便利性;识别脆弱老年群体,推动健康资源向其倾斜;推动社区搭建兴趣活动与互助平台,鼓励老年人社会参与.
Objective To investigate the impact of community environment on frailty among older adults,and examine the me-diating role of health inequality and the moderating role of social participation in the relationship between community environment and frailty.Methods Data were derived from the 2011 community survey and the 2018 individual follow-up survey of the China Health and Retirement Longitudinal Study(CHARLS).A total of 7,483 participants were included in the study.Information on community environment,frailty,health inequality,social participation,and demographic characteristics was collected.The PROCESS macro for SPSS was used to test the mediating effect of health inequality and the moderating effect of social participa-tion,and a simple slope plot was constructed.Results Community environment negatively predicted frailty among older adults(β=-0.298,P＜0.001).Health inequality partially mediated the relationship between community environment and frailty,with a mediating effect of-0.0803,accounting for 26.95％of the total effect(-0.298).Social participation moderated the pathway through which health inequality influenced frailty(β=-0.6178,P＜0.001),specifically moderating the second half of the me-diating pathway.Simple slope analysis revealed that in the low social participation group,health inequality had a stronger positive-ly predictive effect on frailty(β=9.1072,P＜0.001),while in the high social participation group,this predictive effect was weaker(β=7.2537,P＜0.001).Conclusion Community environment and health inequality are significant factors influencing frailty in older adults.Health inequality mediates the relationship between community environment and frailty,and social partici-pation moderates the second half of this mediating pathway.High social participation can attenuate the negative impact of health inequality on frailty.It is recommended to prioritize the improvement of communities with poor basic conditions,focus on the trav-el safety and convenience of public activity space,identify the vulnerable elderly group,establish social platforms for older adults,and encourage the participation of the elderly population.
符皓源;杨芳
浙江中医药大学人文与管理学院,浙江 杭州 310053浙江中医药大学人文与管理学院,浙江 杭州 310053
医药卫生
社区环境衰弱健康不平等社会参与中介作用调节作用
community environmentfrailtyhealth inequalitysocial participationmediating rolemoderating role
《中国卫生事业管理》 2026 (8)
857-863,7
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