中国中老年人失能状况公平性与影响因素

Research on equity and influencing factors of disability among Chinese middle-aged and old people

目的:分析中国50岁及以上中老年人失能状况和失能状况公平性,并探究中老年人失能状况不公平的主要影响因素。方法:利用全球老龄化与成人健康研究(Study on Global Ageing and Adult Health,SAGE)中国2007—2010年第一轮调查数据,计算集中指数和集中曲线,并对集中指数进行分解。结果:中国中老年人失能评估量表平均分为7.32,中老年男性平均分为6.37,女性平均分为8.21。中老年人失能状况集中指数为-0.1909,中老年男性为-0.1844,中老年女性为-0.1961。对集中指数进行分解后,社会经济地位对中老年人失能状况不公平的贡献较高,包括经济水平、受教育程度和工作类型,贡献率分别为66.41%、16.45%和13.10%。与社会结构因素相比,中老年人吸烟、饮酒和身体活动情况等个人生活方式因素的贡献率较低。结论:中国存在中老年人失能状况不公平,较好的健康状况集中在经济水平较好的中老年人群中。中老年男性失能状况较女性更轻,且失能状况不公平程度更小。经济水平、受教育程度和工作类型是对中国中老年人失能状况不公平贡献率较高的主要因素,提示仅通过促进中老年人健康生活方式不能够有效减少失能状况在经济水平较好和较差的中老年人群中的差异。政府需要在重视促进中老年人健康的基础上,进一步加强和完善适宜的社会和医疗保障措施,将减少中老年人健康不公平作为政策重点,尤其应该向发展相对滞后、中老年人相对聚集的地区重点分配医疗卫生和其他相关社会资源,同时应该加大对中老年人健康和健康公平相关研究的支持,为积极应对人口老龄化和制定政策收集证据。

Objective:To evaluate disability status and equity of the middle-aged and old population in China,and to explore the influencing factors contributing to the inequity of disability.Methods:This study was based on data collected from the first wave survey(2007—2010)of World Health Organization Study on Global Ageing and Adult Health(SAGE).Concentration index(CI)and concentration curve were calculated to measure the economic-related inequity of disability among the Chinese middle-aged and old people.The CI was further decomposed in which the attributions of social and individual determinants were calculated.Results:The mean score of the World Health Organization Disability Assessment Sche-dule(WHODAS)was 7.32 among the Chinese middle-aged and old people,6.37 for males and 8.21 for females.The CI for the whole participants was-0.1909,compared with-0.1844 for the middle-aged and old men and-0.1961 for the women.After decomposition of the CI,socioeconomic status contributed most to disability inequity among the Chinese middle-aged and old population.Financial status,educational level and work type contributed 66.41%,16.45%and 13.10%respectively to inequity of disability.Individual lifestyle factors,including tobacco use,alcohol consumption and physical activities,contributed less to inequity of disability compared with social structural determinants.Conclusion:There was inequity of disability among Chinese middle-aged and old population,and those with better financial status were less likely to suffer from functional disability.Middle-aged and old males were less disabled than females,and had less inequity of disability.Financial status,educational level and work type took the highest contribution to inequity of disability among Chinese middle-aged and old population,suggesting that promoting healthy lifestyles alone cannot effectively reduce the inequity of disability.The government needs to continually strengthen and improve appropriate social and medical protection measures on the basis of the importance it attaches to the health of the middle-aged and old population,and makes reducing health inequities a policy priority.The government should pay attention to the provision of healthcare and other resources in areas where development is relatively lagging and where there is a relative concentration of middle-aged and old population.Meanwhile,there should be more significant support for research on health status and equity among the middle-aged and old population to obtain more evidence for proactive responses to rapid population aging in China and policy development.