我国老年人健康状况性别差异及影响因素研究

Gender difference in health status of the Chinese elderly and related influencing factors

目的分析我国老年人健康状况的性别差异及社会经济地位(socioeconomic status,SES)的影响。方法选择中国老年人健康影响因素跟踪调查(Chinese longitudinal healthy longevity survey,CLHLS)2018年数据,描述老年人抑郁症状、失能及认知障碍现状,并采用多因素非条件logistic回归进行影响因素分析。结果我国老年女性抑郁症状、日常生活活动能力(activity of daily living,ADL)失能、认知障碍发生率分别为43.45%、11.67%、22.57%,男性分别为35.76%、9.16%、14.94%,女性分别为43.45%、11.67%、22.57%,差异有统计学意义(χ^(2)=42.18、11.71、66.22,P<0.01)。多因素非条件logistic回归分析显示,控制性别、年龄、婚姻状况、居住情况、居住地等混杂因素后,教育和自评经济是三者共同的影响因素,教育年限6~10年组的老年人发生抑郁症状(OR=0.87,95%CI:0.74~0.96)、认知障碍(OR=0.49,95%CI:0.41~0.58)、ADL失能(OR=0.83,95%CI:0.68~0.94)的风险低于教育年限0年组;经济状况不富裕组的老年人发生抑郁症状(OR=3.37,95%CI:2.76~4.12)、认知障碍(OR=1.48,95%CI:1.15~1.91)、ADL失能(OR=1.22,95%CI:1.07~1.38)的风险高于富裕组;纳入教育和自评经济后,ADL失能的性别差异无统计学意义(P=0.19),而女性抑郁症状(OR=1.33,95%CI:1.20~1.47)和认知障碍(OR=1.30,95%CI:1.15~1.49)的风险仍高于男性;无论是老年男性还是女性,低SES时发生抑郁症状(OR=1.65,95%CI:1.33~2.04;OR=2.14,95%CI:1.64~2.80)和认知障碍(OR=1.79,95%CI:1.32~2.43;OR=3.24,95%CI:2.17~4.84)的风险都最高;当女性处于高SES时,发生抑郁症状(OR=1.21,95%CI:0.83~1.52)和认知障碍(OR=0.93,95%CI:0.58~1.48)的风险与高SES男性差异无统计学意义。结论我国老年女性健康状况不如男性,SES是影响老年健康的重要因素。

Objective To analyze the gender difference and impact of socioeconomic status(SES)on health status of the elderly,in order to facilitate the elimination of gender health inequality.Methods Data of 2018 Chinese longitudinal healthy longevity survey(CLHLS)were used to describe depressive symptoms,disability and cognitive impairment in the elderly,and multivariate unconditional logistic regression was adopted to analyze the influencing factors.Results The prevalence of depressive symptoms,disability and cognitive impairment were significantly higher in elderly women than in elderly men(43.45%vs.35.76%,11.67%vs.9.16%,22.57%vs.14.94%;χ^(2)=42.18,11.71,66.22,P<0.01).Multivariate logistic regression analysis showed that after controlling confounding factors,education and financial self-assessment were major influencing factors.Older participants with 6-10 years of education had lower risks of depressive symptoms(OR=0.87,95%CI:0.74-0.96),cognitive impairment(OR=0.49,95%CI:0.41-0.58)and disability(OR=0.83,95%CI:0.68-0.94)compared to those with no education at all,while participants with low income had higher risks of depressive symptoms(OR=3.37,95%CI:2.76-4.12),cognitive impairment(OR=1.48,95%CI:1.15-1.91)and disability(OR=1.22,95%CI:1.07-1.38)compared to those with high income.The gender difference in disability was not statistically significant after including education and financial self-assessment(P=0.19),while the risks of depressive symptoms(OR=1.33,95%CI:1.20-1.47)and cognitive impairment(OR=1.30,95%CI:1.15-1.49)in elderly women remained higher than in elderly men.In both men and women,the risks of depressive symptoms(OR=1.65,95%CI:1.33-2.04;OR=2.14,95%CI:1.64-2.80)and cognitive impairment(OR=1.79,95%CI:1.32-2.43;OR=3.24,95%CI:2.17-4.84)increased with reduced SES.The differences in the risks of depressive symptoms and cognitive impairment were not statistically significant between elderly women and men with high SES.Conclusions The health of elderly women is inferior than that of elderly men,and SES is the major factor affecting health status of the elderly.