中国高龄老年人临终医疗费用的影响因素及其城乡差异分析

Urban-rural Differences in Factors Associated with End-of-life Medical Expenditures among the Oldest-old in China

背景 临终医疗费用是卫生健康领域的重要研究方向,目前关于中国老年人临终医疗费用的研究较少,尤其缺乏分析中国城乡老年人临终医疗费用差异成因的研究。目的 探讨中国高龄老年人(≥80岁)临终前一年医疗费用的影响因素,分析城乡高龄老年人临终前一年医疗费用的差异及其成因。方法 于2021年9月,采用中国老年人健康影响因素跟踪调查(CLHLS)2018年数据,选取临终前一年医疗支出相关数据及其他重要信息完整的、于2014—2018年死亡的1 399例高龄老年人为研究对象,利用普通最小二乘(OLS)回归分析高龄老年人临终前一年医疗费用的影响因素,采用Oaxaca-Blinder分解方法对城乡高龄老年人在临终前一年医疗费用上的差异进行分析。结果 1 399例高龄老年人中位临终前一年医疗费用为3 500.00(9 000.00)元[对临终前一年医疗费用取对数后的平均值为(8.09±1.73)元]。高龄老年人临终前一年医疗费用受到居住地区、死亡年龄、性别、婚姻状况、居住安排、失能情况、有无参加养老保险、死亡地点、医疗服务是否可及、是否卧床、家庭年人均收入的影响(P<0.05)。在控制其他变量的情况下,城市高龄老年人的临终前一年医疗费用比农村高龄老年人高42.6%。Oaxaca-Blinder分解结果显示,在城乡高龄老年人临终前一年医疗费用差异中,可解释部分和不可解释部分分别为32.86%和67.14%;其中可解释部分差异的18.70%是由养老保险参保情况不同造成的,30.18%是由死亡地点不同造成的,40.42%是由家庭年人均收入不同造成的。结论 中国高龄老年人临终前一年医疗费用的影响因素复杂,且存在较大的城乡差异。建议通过实行健康老龄化战略、均衡城乡医疗资源配置、完善老年社会保障体系和发展临终关怀事业等措施减少高龄老年人临终医疗支出,并提升临终高龄老年人的生存和死亡质量。

Background The cost of end-of-life care is an important topic in health and wellness sector.There are few studies focus on the end-of-life medical expenditures of older adults in China,especially the causes of urban-rural differences in end-of-life medical expenditures in this population.Objective To investigate the associated factors of medical expenditures of Chinese oldest old population(≥80 years)in the year before their death,and to analyze rural-urban differences in the medical expenditures as well as their causes.Methods In September 2021,1399 oldest-old adults who died in 2014—2018 with full data of medical expenditure and other key variables in the year prior to their death were selected from the participants of Chinese Longitudinal Healthy Longevity Survey 2018.Ordinary least squares regression was used to analyze the associated factors of the medical expenditures.The Oaxaca-Blinder technique was used to decompose urban-rural differences in the expenditures.Results The median medical expenses of the participants in the year prior to their death was 3500.00 yuan,and the interquartile range was 9000.00 yuan,the logarithmic mean value was(8.09±1.73)yuan.The residence,age at death,gender,marital status,living arrangement,prevalence of disability,prevalence of endowment insurance,place of death,accessibility of medical services,prevalence of being confined to bed,and annual household income per capita were factors associated with the medical expenditures in the year prior to death(P<0.05).After controlling for confounding factors,the medical expenses of the urban participants in the year prior to their death was 42.6%higher than that of participants living in rural areas.According to the findings of Oaxaca-Blinder decomposition,the explainable and unexplainable parts of the urban-rural differences accounted for 32.86%and 67.14%,respectively.Of the explainable part,18.70%was caused by differences in endowment insurance participation,30.18%by differences in place of death,and 40.42%by differences in annual household income per capita.Conclusion The medical expenditures in the year prior to death in the oldest-old were associated with complex factors,and showed large urban-rural differences.It is essential that efforts should be made to implement healthy aging strategies,balance the allocation of urban and rural medical resources,improve social security system for older adults,and to develop end-of-life care.All of these will help reduce the medical expenditures and improve the quality of life and death of older adults at the end of their life.