病与非病:老年主客观健康一致性评估及其影响因素分析

The Consistency Evaluation of Subjective Health and Objective Health of the Elderly and its Influencing Factors

健康风险认知是个体对疾病、行动能力等躯体健康主观评价的有效程度,但往往主观健康信念和客观事实之间存在偏差而导致非健康管理行为。本文利用2015年中国健康与养老追踪调查数据及血检数据(CHARLS),对老年主观健康、客观健康的一致性程度进行评估。研究发现,老年主客观健康之间存在一致性偏差,一定程度上混肴了"病与非病"的界限。年龄作为影响健康的决定因素,对主客观健康一致性具有显著影响:60至75岁老年人疑病而非病,60岁以下、75岁以上老年人则信无病而病。女性主客观健康一致性程度高,男性主观健康显著高于客观健康。受教育水平低、居住条件一般、收入有限等社会经济地位弱势者的健康标准低而报告高的自评健康,割裂了主客观健康之间的同一性。本文优势在于:一是将一维的主观健康上升到二维的主观健康、客观健康,围绕两者之间的差异展开健康指标的有效度量。二是主客观健康之间的非一致性强调了主观健康作为客观健康替代所存在的风险,而基于主观健康展开的健康福利、健康公平等研究大多高估事实健康,由此可能加剧健康不平等。

Health risk perception means the efficiency of an individual’s subjective evaluation of his physical health,but the inconsistencies between subjective health evaluation and objective health status can often lead to unhealthy management behaviors.Utilizing the data of Chinese Health and Retirement Longitudinal Survey conducted(CHARLS)in 2015,this study evaluates the degree of consistency between subjective health and objective health.The findings show that the elderly confuse the boundary of illness and non-illness to some extent because of the deviation between subjective and objective health evaluation.The elderly aged 60 to 75 tend to have more negative subjective health self-evaluation with actual good objective health,whereas the elders under 60 and over 75 holds more positive health recognition with actual poor health status.Besides,female elders’subjective and objective health have more consistency,while the male elder’s subjective health scores significantly higher than objective health.Finally the elders with low education,poor living conditions,and limited income have lower actual health status but report high self-rated health.The breaking identity between subjective and objective health leading to deviations in health perception and improper health management.This article advantages in introducing a framework of considering two-dimensional health evaluations of the elders and their consistence instead of traditional one-dimensional health evaluation,and the inconsistency between subjective and objective health implies the risks of alternating objective health by subjective health studies about the health wellfare and equity can over estimate the elders’actual health condition and cause more potential health inequity.