Abstract: Objective　To explore the effects of number and types of chronic diseases on activities of daily living（ADL） abilities among the elderly in China.Methods　From November 2015 to March 2016，7 970 respondents aged 60 or over who received ADL survey were analyzed by adopting the trace data in China Health and Retirement Longitudinal Study in 2013.According to the sickness status of chronic diseases of respondents and situations of ADL and instrumental activities of daily living（IADL） disability，the effects of number and types of chronic diseases on ADL and IADL of the elderly were analyzed by Logistic regression analysis.Results　Of the 7 970 research objects，1 762（22.1%）with no chronic diseases，5 061（63.5%） with 1 to 3 types of chronic diseases，1 059（13.3%）with 4 to 6 types，and 88（1.1%）with at least 7 types；chronic diseases with the top three prevalence were arthritis/rheumatism（37.6%，2 999/7 970），hypertension（35.8%，2 857/7 970）and stomach diseases（24.2%，1 928/7 970）；rates of ADL and IADL disability were 23.8%（1 898/7 970）and 35.4%（2 822/7 970）respectively.There were significant difference in rates of ADL and IADL disability between subjects with different number of chronic diseases（P<0.01）；the rate of ADL disability of patients with hypertension，dyslipidemia，diabetes，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，mentally emotional problems，memory-related diseases，arthritis/rheumatism and asthma was higher than that of patients without corresponding chronic diseases（P<0.05）；the rate of IADL disability of patients with hypertension，malignant tumor，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，mentally emotional problems，memory-related diseases，arthritis/rheumatism and asthma was higher than that of patients without corresponding chronic diseases（P<0.05）.Multivariate Logistic regression analysis showed that the number people suffering from chronic diseases was the influence factor of ADL and IADL disability on condition that the specific chronic diseases were not taken as independent variables（P<0.001）；when the specific chronic diseases were taken as independent variables，hypertension，dyslipidemia，diabetes，chronic lung diseases，heart diseases，stroke，kidney diseases，stomach diseases，memory-related diseases，arthritis/rheumatism were the influence factors of ADL disability（P<0.05）；1 to 3 types of chronic diseases，4 to 6 types of chronic diseases，malignant tumor，chronic lung diseases，heart diseases，stroke，mentally emotional problems，memory-related diseases，and arthritis/rheumatism were the influence factors of IADL disability（P<0.05）.Conclusion　The number of chronic diseases is not the most important influencing factor of ADL among the elderly.Attention should be paid to specific chronic diseases,including stroke and memory-related diseases.

Key words: Chronic disease, Aged, Activities of daily living

摘要： 目的　探讨患慢性病数量和种类对中国老年人日常生活活动能力（ADL）的影响。方法　于2015年11月—2016年3月使用中国健康与养老追踪调查2013年全国追踪数据对60岁及以上且接受ADL调查的7 970例受试者进行分析，根据受试者慢性病患病情况及ADL和工具性日常生活自理能力（IADL）的损失情况，采用Logistic回归分析慢性病数量及种类对老年人ADL和IADL的影响。结果　7 970例受试者中，无慢性病1 762例（22.1%），患1～3种慢性病5 061例（63.5%），患4～6种慢性病1 059例（13.3%），患≥7种慢性病88例（1.1%）；慢性病患病率位列前3的依次为关节炎/风湿（37.6%，2 999/7 970）、高血压（35.8%，2 857/7 970）、胃部疾病（24.2%，1 928/7 970）；ADL损失率为23.8%（1 898/7 970），IADL损失率为35.4%（2 822/7 970）。不同慢性病数量者ADL、IADL损失率比较，差异均有统计学意义（P<0.001）；患有高血压、血脂异常、糖尿病、慢性肺部疾病、心脏病、脑卒中、肾脏疾病、胃部疾病、精神情感问题、记忆相关疾病、关节炎/风湿、哮喘者ADL损失率高于无相应慢性病者（P<0.05）；患有高血压、恶性肿瘤、慢性肺部疾病、心脏病、脑卒中、肾脏疾病、胃部疾病、精神情感问题、记忆相关疾病、关节炎/风湿、哮喘者IADL损失率高于无相应慢性病者（P<0.05）。多因素Logistic回归分析结果显示，在具体慢性病不作为自变量时，患慢性病数量是影响老年人存在ADL和IADL损失的因素（P<0.001）；具体慢性病作为自变量时，高血压、血脂异常、糖尿病、慢性肺部疾病、心脏病、脑卒中、肾脏疾病、胃部疾病、记忆相关疾病、关节炎/风湿是影响老年人ADL损失的因素（P<0.05）；慢性病数量为1～3种和4～6种、恶性肿瘤、慢性肺部疾病、心脏病、脑卒中、精神情感问题、记忆相关疾病、关节炎/风湿是影响老年人IADL损失的因素（P<0.05）。结论　患慢性病的数量不是老年人ADL重要的影响因素，应重点关注包括脑卒中、记忆相关疾病等在内的特定慢性病。

关键词: 慢性病, 老年人, 日常生活活动