衰弱和共病对中老年人卫生服务利用及医疗费用支出的影响--基于CHARLS数据的分析

The impact of frailty and comorbidity on health services utilization and medical expenses of middle-aged and elderly people--analysis based on CHARLS data

目的 探析衰弱和共病及其两者交互对中老年人卫生服务利用及医疗费用支出的综合影响,为中老年慢性病管理和老龄化社会健康治理提供实证依据。方法 选取2011年和2013年中国健康与养老追踪调查(CHARLS)数据中年龄在45岁及以上的中老年人群,调查其衰弱和共病情况、门诊和住院服务利用及医疗费用支出,分别利用Logistic回归和Tobit回归模型进行分析。结果 处于衰弱前期和衰弱状态的老年人比例分别为62.6%和10.4%。衰弱和共病的老年人,在卫生服务利用和医疗费用支出上的差异有统计学意义(P<0.001)。衰弱老年人门诊使用的风险是没有衰弱的老年人的1.30倍(P<0.01),且门诊费用平均高1 854.7元;同时处于衰弱和共病状态的老年人门诊使用和住院使用的风险是没有衰弱和共病老年人的2.36倍和2.52倍(均P<0.001),门诊和住院费用分别平均增加6 345.6元和13 611.2元。结论 衰弱和共病共同导致中老年人门诊和住院服务利用及医疗费用支出增加,同时伴有衰弱和共病状况的被调查者其卫生服务利用可能性最高,费用支出也最高。需要重点关注和干预同时处于衰弱和共病状态的中老年人。

Objective To explore the comprehensive impact of frailty and comorbidity and their interaction on health services utilization and medical expenses of middle-aged and elderly people so as to provide empirical evidence for the management of chronic diseases of middle-aged and elderly people and the health governance of aging society. Methods The middle-aged and elderly people aged 45 and above were selected from the CHARLS data in 2011 and 2013. Their frailty and comorbidity, utilization of outpatient and inpatient services, and medical expenses were investigated. Logistic regression and Tobit regression models were used. Results The proportion of the elderly in pre-frail and frail status was 62.6% and 10.4%, respectively. There were statistically significant differences in health services utilization and medical expenses between elderly people with frailty and those in co-morbid conditions(P<0.001). The risk for outpatient service utilization of the frail elderly was 1.30 times higher than that of the non-frail elderly(P<0.01), with an average outpatient cost of 1 854.7 Yuan higher. The risk for outpatient utilization and inpatient utilization of the elderly who were in the states of frailty and comorbidity were 2.36 times and 2.52 times higher than those of the elderly who were not in the states of frailty and comorbidity(both P<0.001). The outpatient and inpatient expenses increased by 6 345.6 Yuan and 13 611.2 Yuan on average, respectively. Conclusions Frailty and comorbidity together lead to the increase of utilization of outpatient and inpatient services and medical expenses for the middle-aged and elderly. The respondents with frailty and comorbidity have the highest possibility of using health services and the highest expenses. It is necessary to focus on and intervene the middle-aged and elderly people with both frailty and comorbidity.