中国老年人口健康状态转移规律与失能预防策略研究

The Regularity in the Elder's Health Status Transition and Its Implication on Disability Prevention

随着人类平均预期寿命延长,老年慢性病患病率与失能率快速上升。文章使用CHARLS2011~2020年调查数据构建健康状态转移模型,分析了老年人口的健康状态转移规律,并以慢性病综合防控示范区的设立为准自然实验,检验了慢性病综合防控对中老年人失能的影响。研究发现,“健康→慢性病(并发症)→失能”是老年人健康状态转移的一般规律,慢性病是导致老年人失能的主要原因。随着年龄增长,老年人由健康状态转移至慢性病状态的概率持续上升,75岁以后超过50%;由慢性病状态转移至失能状态的概率远高于自然失能的概率,全生命周期防控慢性病是预防老年人失能的重要途径。慢性病综合防控通过提高个体健康监测概率、提升慢性病知晓率和加强慢性病管理工作,能够有效降低老年人的失能概率和失能程度;在医疗资源匮乏、医疗服务质量偏低的地区,失能预防效果更加显著。文章结论能够为失能预防工作提供决策参考,有助于全面推进健康中国建设。

Along with the expanding life expectancy,chronic diseases and disability risks increase rapidly among the elderly.This study uses the data of CHARLS 2011-2020 to construct a health status transition model,and explores the regularity in the elder's health status transition.It also tests the impact of the comprehensive prevention and control of chronic diseases on disability prevention,by taking the establishment of the Demonstration Area for Comprehensive Prevention and Control of Chronic Diseases as a quasi-natural experiment.We find a salient health status transition trajectory from healthy statas to disability via chronic diseases(and complications)in the elderly population,and chronic diseases play an important role in disability incidence for the elderly.The probability of transiting from a healthy state to having chronic diseases continues to increase as one ages,and it exceeds 50%after the age of 75.The probability of transiting from chronic disease to disability is much greater than the disability probability without chronic diseases.Therefore,it is an important pathway to prevent and control chronic diseases through life time as to prevent disability in the elderly.The comprehensive prevention and control of chronic diseases can effectively reduce the middle-aged and elderly's incidence as well as severity of disability by increasing health monitoring,improving knowledge on chronic diseases,and strengthening the chronic diseases treatment.The effect is more pronounced in the areas with fewer medical resources and lower medical service quality.The conclusive remark is made on strategies of disability prevention decision-making and health promotion in China.