中国老年人躯体慢性病共病的复杂模式及其对卫生服务利用影响研究

Complex Pattern of Multiple Chronic Physical Conditions and Its Effect on Healthcare Utilization among Older Adults in China

背景 我国老年人慢性病共病患病率不断上升,但既往研究缺乏从慢性病患者需求和管理的视角对慢性病共病模式进行研究。目的 探究我国老年人群躯体慢性病共病的复杂模式分布、影响因素及相应的卫生服务利用情况。方法 本研究数据来源于2018年和2020年中国健康与养老追踪调查(CHARLS),选取≥60岁老年人作为研究对象(n=15 349),分别使用广义有序逻辑回归和广义线性模型探究慢性病共病复杂模式的影响因素及其与门诊、住院服务利用和费用的相关性。所有统计分析除样本量外进行加权处理。结果 15 349名老年人中,2018年7 147人、2020年8 202人;相对健康(不患本研究定义的12种慢性病)2 054人(13.0%,即相对健康组),患1~5种非复杂慢性病5 228人[33.7%,即简单慢性(共)病组],患1~2种复杂慢性病和<6种非复杂慢性病6 737人[44.7%,即轻微复杂慢性(共)病组],患≥3种复杂慢性病或≥6种非复杂慢性病1 330人(8.6%,即重大复杂慢性病共病组)。与2018年相比,2020年轻微复杂慢性(共)病组和重大复杂慢性病共病组占比分别上升了2.1%和1.9%。在简单慢性(共)病组和轻微复杂慢性(共)病组中,患病率较高的慢性病主要为高血压(49.2%和56.1%)和关节炎/风湿病(51.9%和47.4%)。在重大复杂慢性病共病组中,82.0%患有心脏病、67.9%患有慢性肺部疾病。三组老年人躯体慢性病患病率比较,差异有统计学意义(P<0.05)。年龄、性别、受教育程度、家庭人均年消费、医疗保险、抑郁、调查年份对简单慢性(共)病组、轻微复杂慢性(共)病组、重大复杂慢性病共病组有影响(P<0.05);年龄、受教育程度、城乡分布、地域、家庭人均年消费、调查年份对轻微复杂慢性(共)病组、重大复杂慢性病共病组有影响(P<0.05);年龄、地域、家庭人均年消费、抑郁、调查年份对重大复杂慢性病共病有影响(P<0.05)。在2018年,相较于相对健康组,轻微复杂慢性(共)病组、重大复杂慢性病共病组门诊就诊次数更多,简单慢性(共)病组、轻微复杂慢性(共)病组、重大复杂慢性病共病组门诊费用、住院次数和费用均更高(P<0.05)。在2020年,相较于相对健康组,简单慢性(共)病组、轻微复杂慢性(共)病组、重大复杂慢性病共病组门诊就诊次数和住院次数均更多(P<0.05)。结论 基于CHARLS最新数据显示,我国半数以上老年人患有复杂慢性病共病,其中44.7%为轻微复杂慢性病共病,8.6%患重大复杂慢性病共病。重大复杂慢性病共病患者中患病率较高的前2位复杂慢性病为心脏病和慢性肺部疾病,同时,随着慢性病共病复杂程度的增加,相应的门诊及住院的利用和费用水平明显上升,建议从医疗需求出发探究慢性病共病有效管理模式,以提高健康水平和降低疾病负担。

Background The prevalence of multiple chronic conditions(MCCs)is continuously increasing among older adults in China,but few studies have explored complex pattern of MCCs from perspectives of patient demand and disease management.Objective This study aims to investigate the pattern distributions,correlates,and treatment burdens of MCCs.Methods Data were obtained from the 2018 and 2020 China Health and Retirement Longitudinal Study(CHARLS)waves,and the study sample included older adults aged ≥ 60 years old(n=15 349).The generalized ordered logit model and the generalized linear model were used to examine correlates of MCCs complex pattern and its associations with outpatient/inpatient utilization and expenditure,respectively.All statistical analyses were weighted except for sample size.Results Among the total sample of 15 349 older adults,there were 7 147 in 2018 and 8 202 in 2020;2 054 participants[13.0%,defined as the relatively healthy group(RH group)] had none of 12 chronic conditions defined in this study,5 228 participants [33.7%,defined as the simple chronic illness group(SCI group)] had 1-5 non-complex chronic conditions,6 737 participants [44.7%,defined as the minor complex chronic illness group(MiCCI group)] had 1-2 complex chronic conditions,and <6 non-complex chronic conditions,and 1 330 participants[8.6%,defined as the major complex chronic illness group(MaCCI group)] had ≥ 3 complex chronic conditions or ≥ 6 non-complex chronic conditions.The proportion of MiCCI and MaCCI groups had an increase of 2.1% and 1.9% between 2018 and 2020,respectively.Among the SCI and MiCCI groups,the most prevalent chronic conditions were hypertension(49.2% and 56.1%)and arthritis/rheumatism(51.9% and 47.4%),respectively.Among MaCCI group,82.0% had heart disease,and 67.9% had chronic lung diseases.There were statistically significant differences in the prevalence of chronic conditions among the three groups(P<0.05).Age,sex,education level,annual household expenditure per capita,medical insurance,depression status,and survey year were associated with being in SCI,MiCCI,and MaCCI groups(P<0.05);age,education level,urban-rural location,region,annual per capita household expenditure,and survey year were associated with being in MiCCI and MaCCI groups(P<0.05);age,region,annual per capita household expenditure,depression status,and survey year were associated with being in MaCCI group(P<0.05).In 2018,compared to the RH group,the MiCCI and MaCCI group had more outpatient numbers,and the SCI,MiCCI,and MaCCI groups had higher outpatient expenses,inpatient numbers and expenses(P<0.05).In 2020,compared to the RH group,the SCI,MiCCI,MaCCI groups utilized more outpatient and inpatient services(P<0.05).Conclusion According to the most recent CHARLS data,over half of older adults in China suffers from complex chronic comorbidities,with 44.7% for the MiCCI group and 8.6% for MaCCI group.The heart disease and chronic lung disease was the most prevalent in the MaCCI group.Furthermore,as the complexity of multimorbidity increases,there is a noticeable increase in outpatient and inpatient utilization as well as medical expenditures.Therefore,it is recommended to explore effective MCC management models based on healthcare demands to improve health outcomes and reduce disease burdens.