我国中老年人群丧偶对自评健康状况的影响

Impact of loss of a spouse on self-rated health among middle-aged and elderly populations in China

目的探讨我国中老年人群丧偶对自评健康状况的影响,为丧偶中老年人群健康促进提供参考。方法基于2018年中国健康与养老追踪调查(CHARLS)数据库纳入≥45岁、婚姻状况为已婚但未长期分居或已丧偶、家庭月消费不低于100元的人群为研究对象,收集年龄、性别、受教育程度、婚姻状况、家庭月消费、患慢性病数量和自评健康状况等资料。按是否丧偶为标准划分样本,采用倾向得分匹配(PSM)分析中老年人群丧偶对自评健康状况的影响;并按性别和受教育程度进行异质性检验。结果纳入有效样本3272人,男性1618人,占49.45%;女性1654人,占50.55%。丧偶512人,占15.65%。自评健康为很好656人,占20.05%;好622人,占19.01%;一般1534人,占46.88%;不好376人,占11.49%;很不好84人,占2.57%。最近邻匹配成功3152对,丧偶人群与非丧偶人群各控制变量间的差异均无统计学意义(P>0.05),匹配后模型总体拟合程度较好。PSM结果显示,丧偶会使中老年人群自评健康状况变差,平均干预效应值(ATT)为0.055~0.061;丧偶对女性自评健康状况的负面影响较为明显,ATT值为0.192~0.223,而对男性的影响不明显;丧偶对接受中高等教育人群自评健康状况的负面影响较为明显,ATT值为0.048~0.057,而对接受初等教育人群的影响不明显。结论中老年人群自评健康状况会受到丧偶事件的负面影响,其中女性、受教育程度较高人群受到的影响更为明显。

Objective To evaluate the impact of loss of a spouse on self-rated health among middle-aged and elderly populations in China,so as to provide insights into health promotion among middle-aged and elderly populations with loss of a spouse.Methods Based the 2018 China Health and Retirement Longitudinal Study(CHARLS)database,married and separated individuals or individuals with loss of a spouse at ages of 45 years and older and with monthly household consumption of no less than 100 yuan were enrolled.Subjects'age,gender,educational levels,marital status,monthly household consumption,number of chronic diseases and self-rated health were collected.Subjects were classified according to loss of a spouse,and the impact of loss of a spouse on self-rated health was evaluated among middle-aged and elderly populations using propensity score matching(PSM).In addition,heterogeneity test was performed to evaluate the gender-and educational level-stratified impacts.Results Totally 3272 valid subjects were enrolled,including 1618 men(49.45%)and 1654 women(50.55%),and there were 512 subjects with loss of a spouse(15.65%).There were 656 subjects with very good self-rated health(20.05%),622 with good health(19.01%),1534 with fair health(46.88%),376 with poor health(11.49%)and 84 with very poor health(2.57%).There were 3152 couples with successful nearest neighbor matching,and there was no significant difference between the subjects with and without loss of a spouse after adjustment for variables(P>0.05),while the overall fitting degree of the model was good following matching.PSM showed that the self-rated health became poor following loss of a spouse among middle-aged and elderly populations,with average treatment effect(ATT)of 0.055 to 0.061,and a remarkably negative effect of loss of a spouse on self-rated health was seen in women,with ATT of 0.192 to 0.223,while no remarkable effect was seen in men.Loss of a spouse showed a remarkably negative effect on self-rated health among individuals receiving junior and senior high educations,with ATT of 0.048 to 0.057,but presented no remarkable effect on self-rated health among individuals receiving primary educations.Conclusions Loss of a spouse presents a negative effect on self-rated health among middle-aged and elderly populations,and remarkably negative effects are seen among women and individuals receiving high educational levels.