多重慢病老年人健康状况差异的分解研究:基于健康双因素的多层模型  

A Decomposition Study of Health Status Disparities among Older Adults with Multimorbidity:a Multiple Level Model Based on Health Double Factors

作　　者：李欣茹 陈慧雯 陈一鸣 薛本立 郑晓 石磊 陈亚光 张持晨 LI Xinru;CHEN Huiwen;CHEN Yiming;XUE Benli;ZHENG Xiao;SHI Lei;CHEN Yaguang;ZHANG Chichen(School of Health Management,Southern Medical University,Guangzhou 510515,China;Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service,Guangzhou 510515,China;Health Education Center of Maoming City,Maoming 525099,China;Department of Health Management,Shunde Hospital,Southern Medical University/The First People's Hospital of Shunde,Foshan 510030,China)

机构地区：[1]南方医科大学卫生管理学院,广东省广州市510515 [2]广东省高校哲学社会科学(健康管理政策与精准健康服务协同创新研究)重点实验室,广东省广州市510515 [3]广东省茂名市健康教育所,525099 [4]南方医科大学顺德医院(佛山市顺德区第一人民医院)健康管理科,510030

出　　处：《中国全科医学》2024年第17期2138-2144,共7页Chinese General Practice

基　　金：国家自然科学基金面上项目(72274091);中国博士后科学基金面上项目(2022M721539);广东省基础与应用基础研究基金(2022A1515011591,2023A1515010902);广东省高校哲学社会科学重点实验室项目(2015WSY0010)。

摘　　要：背景当前,国内针对多重慢病老年人健康状况的影响因素研究较为分散,难以从整体的视角给予全面的考量,且并未探究导致健康差异的因素贡献度大小,以至于现行的健康管理方案通常在多重慢病老年群体中效果不佳。目的通过引入健康双因素模型,了解多重慢病老年人健康的内外生因素及其贡献度大小,旨在为该群体制定精准健康管理方案提供实践依据。方法本文利用中国健康与养老追踪调查(CHARLS)2018年数据,引入由Grossman健康生产函数发展而来的健康双因素模型(包括健康决定因素的内生因素和外生因素两个方面),首先使用Wilcoxon秩和检验分析不同性别下多重慢病老年人健康状况是否存在差异;其次采用OLS回归模型分析健康双因素模型对多重慢病老年人健康的影响机制;最后进一步使用夏普利值方法分解健康内外生因素对其健康的贡献度。结果OLS回归分析结果显示,仍然饮酒、无控制疾病方式、对医疗服务满意、有较高的教育水平、有退休金、未利用医疗服务、参加免费健康体检、照顾孙辈子女、对子女关系满意等因素更有利于提升多重慢病老年人健康水平(P<0.05)。夏普利值分解结果显示,在全样本中社会经济地位是最重要的影响因素,家庭健康支持、危害健康相关行为、疾病应对策略重要性次之,社会健康资源的影响最小。在性别亚组分析中,社会经济地位仍然是排位第一的因素;对于多重慢病老年男性来说,危害健康相关行为成为次重要的因素;对于多重慢病老年女性来说,疾病应对策略的重要性次之。结论多重慢病老年男性健康状况优于女性,社会经济地位是影响多重慢病老年人健康最重要的因素,家庭健康支持、危害健康相关行为、疾病应对策略、社会健康资源对男性和女性健康差异的贡献度大小各不相同,建议应根据不同的健康内外生因素�Background Currently,research on the factors influencing the health status of older adults with multimorbidity in China is scattered,and it is difficult to give a comprehensive consideration from a holistic perspective,and the contribution of factors leading to health disparities is not explored,resulting in the ineffectiveness of current health management often programs in older adults with multimorbidity.Objective By introducing a health bifactor model,this study aims to understand the endogenous and exogenous influencing factors and their contributions to the health of older adults with multimorbidity and provide a practical basis for developing precise health management plans for older adults with multimorbidity.Methods In this study,using the China Health and Retirement Longitudinal Survey(CHARLS)2018 data and introducing the two-factor model of health developed from the Grossman health production function(including both endogenous and exogenous aspects of health determinants).First,the Wilcoxon rank sum test was used to analyze whether there were differences in the health status of older adults with multimorbidity by gender.Secondly,the OLS regression model was used to analyze the mechanism of the two-factor model of health on the health of older adults with multimorbidity.Finally,the Shapley value method was further used to decompose the contribution of health endogenous factors to their health.Results The study found that factors such as still drinking alcohol,having no disease control methods,being satisfied with medical services,having a high level of education,having a pension,not using health services,attending free health checks,caring for grandchildren and being satisfied with their children's relationship were more likely to improve the health of older people with multiple chronic conditions.The results of the Shapley decomposition showed that socioeconomic status was the most important factor in the full sample,while family health support,health-related behaviors,and health-related behaviors were

关 键 词：多重慢病 健康双因素 虚弱指数 健康管理 夏普利值 

分 类 号：R36[医药卫生—病理学]