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中老年人异质化多维健康转移模式及其对医疗服务利用的影响

Heterogeneous multidimensional health transition patterns and their impact on healthcare service utilization among middle-aged and elderly people

  • 摘要:
    目的  从基于大健康视角的生理、心理和社会3个维度,引入潜在的人群异质性,探究中老年人潜在多维健康转移模式及其对医疗服务利用的影响,为精准推进中老年人健康老龄化提供借鉴和参考。
    方法 利用中国健康与养老追踪调查(2011—2018)4期数据,运用重复测量潜在类别分析识别中老年人潜在多维健康转移模式,采用两部模型分析潜在多维健康转移模式对医疗服务利用的影响,其中,第1部分是否利用医疗服务采用logit模型,第2部分针对费用和次数分别采用线性回归模型和负二项回归模型。
    结果 中老年人存在7种多维健康转移模式,分别是“心理健康恶化”(11.11%)、“社会健康恶化”(27.89%)、“生理和社会健康较差”(7.02%)、“心理和社会健康较差”(13.44%)、“持续不健康”(7.09%)、“随访期内死亡”(10.46%)和“持续健康”(22.98%)。各健康转移模式对门诊和住院医疗服务利用存在显著的影响,特别是在是否利用门诊、是否住院以及门诊次数3个方面。相较于“持续健康”组,“心理健康恶化”“生理和社会健康较差”“心理和社会健康较差”和“持续不健康”组的门诊和住院服务利用概率都更高,“社会健康恶化”(OR=0.83,95%CI=0.70~0.98)组的门诊服务利用概率更低(P<0.05),“心理健康恶化”(β=0.30,95%CI=0.03~0.58)和“持续不健康”(β=0.33,95%CI=0.00~0.65)组的门诊服务利用费用更高(P<0.05),“生理和社会健康较差”(β=0.28,95%CI=0.03~0.52)组的住院服务利用费用更高(P<0.05),“心理健康恶化”(IRR=1.48,95%CI=1.27~1.73)、“社会健康恶化”(IRR=1.19,95%CI=1.03~1.38)、“生理和社会健康较差”(IRR=1.28,95%CI=1.06~1.55)、“心理和社会健康较差”(IRR=1.39,95%CI=1.18~1.64)和“持续不健康”(IRR=1.49,95%CI=1.25~1.78)组的门诊服务利用次数更高(P<0.05),“心理健康恶化”住院服务(IRR=1.15,95%CI=1.01~1.32)利用次数更高(P<0.05)。
    结论 我国中老年人中存在7种异质化的多维健康转移模式,各健康转移模式对门诊和住院服务利用的费用和次数存在不同的影响。

     

    Abstract:
    Objective To explore the potential multidimensional health transition patterns of the middle-aged and elderly and their impact on healthcare service utilization from the perspective of physical, psychological, and social dimensions, incorporating potential population heterogeneity, and to provide insights for promoting healthy aging.
    Methods Using four waves of data (2011-2018) from the China Health and Retirement Longitudinal Study (CHARLS), we applied repeated measurement latent class analysis to identify potential multidimensional health transition patterns among middle-aged and elderly. A two-part model was employed to analyze the impact of these patterns on healthcare service utilization. The first part used a logit model to determine whether healthcare services were utilized, while the second part took linear regression and negative binomial regression models for cost and frequency, respectively.
    Results Seven distinct multidimensional health transition patterns were identified the among middle-aged and elderly: “Deteriorating Psychological Health” (11.11%), “Deteriorating Social Health” (27.89%), “Poor Physical and Social Health” (7.02%), “Poor Psychological and Social Health” (13.44%), “Persistently Unhealthy” (7.09%), “Death During Follow-up” (10.46%), and “Persistently Healthy” (22.98%). These health transition patterns significantly influenced both outpatient and inpatient healthcare service utilization, particularly regarding whether outpatient services were used, whether hospitalization occurred, and the frequency of outpatient visits. Compared to the “Persistently Healthy” group, the “Deteriorating Psychological Health,” “Poor Physical and Social Health,” “Poor Psychological and Social Health,” and “Persistently Unhealthy” groups had higher probabilities of utilizing both outpatient and inpatient services. The “Deteriorating Social Health” group (OR=0.83, 95%CI: 0.70-0.98) had a lower probability of utilizing outpatient services (P<0.05). The “Deteriorating Psychological Health” (β=0.30, 95%CI: 0.03-0.58) and “Persistently Unhealthy” (β=0.33, 95%CI: 0.00-0.65) groups incurred higher outpatient service costs (P<0.05), while the “Poor Physical and Social Health” group (β=0.28, 95%CI: 0.03-0.52) had higher inpatient service costs (P<0.05). The “Deteriorating Psychological Health” (IRR=1.48, 95%CI: 1.27-1.73), “Deteriorating Social Health” (IRR=1.19, 95%CI: 1.03-1.38), “Poor Physical and Social Health” (IRR=1.28, 95%CI: 1.06-1.55), “Poor Psychological and Social Health” (IRR=1.39, 95%CI: 1.18-1.64), and “Persistently Unhealthy” (IRR=1.49, 95%CI: 1.25-1.78) groups had a higher frequency of outpatient service utilization (P<0.05). The “Deteriorating Psychological Health” group also had a higher frequency of inpatient service utilization (IRR=1.15, 95%CI: 1.01-1.32) (P<0.05).
    Conclusions Seven heterogeneous multidimensional health transition patterns exist among middle-aged and elderly in China. These patterns differentially affect the cost and frequency of outpatient and inpatient service utilization.

     

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