Page 92 - 南京医科大学自然版

第46卷第8期
·1198 · 南 京 医 科 大 学 学 报 2026年8月

Subpopulation treatment effect pattern plot（STEPP）analysis was further applied to investigate heterogeneity in this association strength
among Chinese older adults. Results：Higher psychological resilience was significantly associated with a lower risk of all ⁃ cause
mortality among Chinese older adults（all P < 0.001）. Significant heterogeneity in the association strength was observed across
subpopulations defined by a body shape index（ABSI）（P < 0.001），body roundness index（BRI）（P < 0.001），waist⁃to⁃height ratio
（WHtR）（P < 0.001），and body mass index（BMI）（P < 0.001）. Conclusion：The association strength between psychological resilience
and all ⁃ cause mortality varies significantly among different subpopulations of Chinese older adults. Older adults classified as
overweight by multiple indices are encouraged to maintain higher levels of psychological resilience to reduce all⁃cause mortality risk.
［Key words］ psychological resilience；mental health；obesity；mortality；old adult
［J Nanjing Med Univ，2026，46（08）：1197⁃1210］

［1］
The“Healthy China 2030”initiative sets in⁃ valuable metrics for self⁃health management.
creasing national life expectancy to 79 years as a pivot⁃ To address these gaps，this study investigated the
al goal for public health development（average life ex⁃ association between psychological resilience and all ⁃
pectancy was 76.34 years in 2015 and 77.30 years in cause mortality in older adults using data from a pro⁃
2020）. Achieving this target requires multifaceted re⁃ spective cohort of 7 481 participants in the Chinese
search into factors that extend life expectancy across Longitudinal Healthy Longevity Survey（CLHLS）. We
diverse populations. further examined the heterogeneity in the association
Psychological resilience，defined as the process strength across subpopulations defined by obesity indi⁃
and outcome of successfully adapting to difficult or ces to identify subgroups deriving the greatest benefits
challenging life experiences，particularly through men⁃ from psychological resilience. Stratified analyses were
tal，emotional，and behavioral flexibility in response to conducted stratifying by ABSI，BRI，WHtR，and BMI，
［2］
external and internal demands ，has emerged as a crit⁃ employing the subpopulation treatment effect pattern
ical determinant of health outcomes. Although previous plot（STEPP）to assess heterogeneity across subpopula⁃
longitudinal studies have linked high psychological re⁃ tions more precisely. These findings provide scientific
silience to lower risks of all⁃cause mortality，disability， evidences for formulating mental health intervention
［3- 4］
and cardiovascular disease ，most have focused on policies targeting obese older adults.
the general population，often overlooking potential het⁃
1 Subjects and methods
erogeneity across subpopulations. Extrapolating health
associations solely from“average effects”may lead to 1.1 Subjects
“one⁃size⁃fits⁃all”errors，masking critical differences We conducted a prospective cohort analysis using
in how various groups respond to protective factors. data from the CLHLS. The CLHLS is a representative，
Obesity is a well⁃established risk factor for multi⁃ population⁃based，prospective cohort study，comprising
ple health⁃related outcomes，including mortality，car⁃ older adults aged ≥65 years and their adult children
［5- 7］
diovascular events，and psychological health . Spe⁃ aged 35-64 years. Participants were randomly sampled
cifically，past obesity has been associated with worse from a frame covering approximately 85% of the older
［7］
current psychological outcomes . To our knowledge， adult population across all Chinese provinces and re⁃
no studies have explored the heterogeneity of this asso⁃ gions.
ciation across subpopulations defined by different obe⁃ The baseline survey was initiated in 1998，with
sity indices. Recently，researchers have developed sev⁃ follow⁃up waves conducted in 2000，2002，2005，2008-
eral easily measurable and calculable obesity indices， 2009，2011- 2012，2014，and 2017- 2018 . For this
［8］
such as a body shape index（ABSI），body roundness in⁃ study，the 2011- 2012 survey（Wave 6）served as the
dex（BRI），waist ⁃ to ⁃ height ratio（WHtR），and body baseline，and the 2017- 2018 survey（Wave 8）as the
mass index（BMI）. These widely used indices offer study endpoint. The 2014 survey（Wave 7）occurred