我国老年慢性病共病模式及灾难性卫生支出分布研究

Study on the Chronic Disease Comorbidities Pattern and the Distribution of Catastrophic Health Expenditure among the Elderly in China

目的:明晰我国老年慢性病共病模式及灾难性卫生支出分布,为制定老年慢性病管理策略提供数据支撑。方法:采用中国健康与养老追踪调查2020年数据,运用潜在类别模型和GeoDa软件分析老年慢性病共病模式及灾难性卫生支出空间分布。结果:2020年老年慢性病共病模式包括循环代谢类疾病,消化、骨骼类疾病,呼吸系统疾病,肿瘤、消化及精神类疾病以及多系统疾病;慢性病共病的灾难性卫生支出发生率为30.12%,空间分布Moran's 1=0.854(P<0.05),存在空间自相关;青海、内蒙古、天津等为高-高聚集,辽宁、吉林、浙江等为低-低聚集。结论:老年慢性病共病灾难性卫生支出的发生呈现疾病特征差异,具有地区和共病模式的不平衡性。建议重视老年慢性病管理,动态调整老年慢性病保障政策,探索实施共病模式医疗保障制度。

Objective:Clarifying the comorbidity patterms of chronie disease and its distribution of catastrophie health expenditure in the elderly,in order to provide scientifie data support for the development of chronie disease management strategies in various regions.Methods:Data were selected from China Health and Retirement Survey.Latent class model and Geoda were used to analyze the mode of chronic disease comorbidities in the elderly and the spatial distribution of catastrophic health expenditures.Results:The comorbidity patterns of chronic diseases in the elderly included circulatory and metabolic diseases,digestive disease,skeletal diseases,respiratory diseases,tumors,digestive and psychiatric diseases,and multisystem diseases.The incidence of catastrophic health expenditure with chronic disease comorbidities was 30.12%,and Moran's I value was 0.854(P<0.05),indicating spatial autocorrelation.Qinghai,Inner Mongolia and Tianjin etc.were high-high areas,while Liaoning,Jilin and Zhejiang ete.were low-low areas.Conclusion:The occurrence of catastrophie health expenditures was characterized by sociodemographic differences and regional and comorbidity patterns of inequality.It is suggested that we should pay more attention to the management of chronic diseases,dynamically adjust the old-age chronie disease insurance policy and explore medical security system with a comorbidity model.