老年人共病模式及其与医疗服务利用的关系研究

Multimorbidity patterns in the elderly and their association with health care utilization

目的 在具有全国代表性的老年慢病患者中识别出共病模式,并探究其与医疗服务利用之间的关系.方法 基于2018年"中国健康与养老追踪调查"(CHARLS)的调查数据,筛选10 764名60岁及以上老年人,采用潜在类别模型识别出老年人共病模式,运用Logistic回归模型分析8 041例变量信息完整的老年人共病模式与医疗服务利用之间的关系.结果 初始的潜在类别分析确定了 5种类别,有4 164例(52.1%)老年人被分到了相对健康组,其他4种类别分别代表不同的共病类型,分别是呼吸系统疾病组473例(5.7%)、血管疾病组1 994例(25.3%)、胃-关节炎/风湿病组984例(11.7%)以及多系统疾病组426例(5.2%).在门诊服务利用方面,与相对健康组相比,多系统疾病组更可能去寻求门诊服务(aOR=2.920,95%CI:2.305~3.699),其次是呼吸系统疾病组(aOR=1.827,95%CI:1.429~2.336)、胃-关节炎/风湿病组(aOR=1.680,95%CI:1.392~2.027)、血管疾病组(aOR=1.482,95%CI:1.267~1.734).在住院服务利用方面,与相对健康组相比,多系统疾病组更可能去寻求住院服务(aOR=2.718,95%CI:2.158~3.425),其次是呼吸系统疾病组(aOR=2.627,95%CI:2.105~3.280)、胃-关节炎/风湿病组(aOR=1.940,95%CI:1.624~2.318)、血管疾病组(aOR=1.887,95%CI:1.632~2.183).结论 老年人共病模式与门诊和住院服务利用之间相关.与相对健康组相比,四种共病模式都增加了门诊和住院的风险.

Objective To identify multimorbidity patterns in a nationally representative sample of elderly patients with chronic diseases and to explore the relationship between these multimorbidity patterns and health care utilization.Methods Based on data from the China Health and Retirement Longitudinal Study(CHARLS)in 2018,10764 elderly people aged 60 years and older were included,and latent class analysis(LCA)was used to identify multimorbidity patterns in the elderly,and the Logistic model was used to analyze the relationship between multimorbidity patterns and healthcare utilization in 8041 elderly people with complete information on the variables.Results The primary LCA identified five categories,with 4164(52.1%)participants belonging to the relatively healthy category.The other four categories represented different patterns of multimorbidity,with 473(5.7%)belonging to the respiratory disease category,1994(25.3%)to the vascular disease category,948(11.7%)to the stomach-arthritis/rheumatism disease category and 426(5.2%)to the multisystemic disease category.In terms of outpatient service utilization,compared with the relatively healthy category,the multisystemic disease category was the most likely one to seek outpatient services(aOR=2.920,95%CI:2.305-3.699),followed by the respiratory disease category(aOR=1.827,95%CI:1.429-2.336),the stomach-arthritis/rheumatism disease category(aOR=1.680,95%CI:1.392-2.027),and the vascular disease category(aOR=1.482,95%CI:1.267-1.734).In terms of inpatient service utilization,compared to the relatively healthy category,the multisystemic disease category was the most likely one to seek inpatient services(aOR=2.718,95%CI:2.158-3.425),followed by the respiratory disease category(aOR=2.627,95%CI:2.105-3.280),the stomach-arthritic/rheumatism disease category(aOR=1.940,95%CI:1.624-2.318),and the vascular disease group(aOR=1.887,95%CI:1.632-2.183).Conclusions There is a significant correlation between multimorbidity patterns and outpatient and inpatient service utilization in the elderly.Compared to relatively healthy people,those with one of the other four multimorbidity patterns have a significantly increased risk needing outpatient and inpatient services.