Regional Differences in Disability and Its Influencing Factors among Middle-aged and Elderly People in Three Major Regions in China
摘要: 背景 我国人口老龄化及重大慢性病问题的加剧，势必会引起失能人口数量的增加，导致社会养老压力增大，政府和家庭养老负担加重。同时，卫生资源配置分配不均衡，将对失能人口的医疗和护理带来更严峻的挑战。目的 探讨我国东、中、西部地区中老年人失能率、失能程度及影响因素的差异。方法 于2022-10-052023-01-13对2018年中国健康与养老追踪调查（CHARLS）数据进行分析，以19 170名45周岁及以上的中老年人作为研究对象，采用日常活动量表（ADL）和工具性日常活动限制量表（IADL）对失能进行判断，将中老年人失能状况和失能程度作为因变量，并根据CHARLS数据调查问卷内容从一般人口学特征、健康评价和生活方式3个方面选取自变量，对东、中、西部中老年人失能状况及失能程度的影响因素进行二分类和多分类 Logistic 回归分析。结果 东、中、西部地区中老年人失能率及失能程度比较，差异具有统计学意义（2 =143.014，P<0.001；2=136.356，P<0.001）。东、中、西部地区中老年人均以轻度失能为主；东、中、西部地区的轻度和重度失能中老年人的年龄构成比较，差异有统计学意义（P<0.05）。三大地区失能及失能程度的影响因素存在共性和特性。年龄、文化程度、自评健康状况是东、中、西部地区中老年发生失能共同的影响因素（P<0.05），性别、躯体残疾是东部中老年人发生失能的独立影响因素（P<0.05），女性中老年人失能的发生的风险比男性高86.0%（OR=1.860，95%CI=1.036~3.338）。婚姻状态、患慢性病是中部中老年人发生失能的独立影响因素（P<0.05）；居住地、大脑受损/智力缺陷是西部中老年人发生失能的独立影响因素（P<0.05）。结论 应针对中老年人失能状况及影响因素的区域差异，制定有针对性的预防和治疗策略，通过加强宣传教育、完善基层-社区健康管理体系建设、提供区域化的医疗服务和康复指导，以降低中老年人失能水平，严防失能程度的加深，缓解区域间失能差异。
Abstract: Background The aging of our population and the intensification of major chronic disease problems will inevitably lead to an increase in the number of disabled people，resulting in increased pressure on social care and a heavier burden on the government and families for the elderly. At the same time，the unbalanced allocation of health resources will pose even more serious challenge to the medical treatment and nursing care of the disabled population. Objective To explore the differences of disability rate，disability degree and influencing factors among middle-aged and elderly people in eastern, central and westernregions of China. Methods Data from the 2018 China Health and Retirement Longitudinal Study（CHARLS） were analyzed from 2022-10-05 to 2023-01-13, and 19 170 middle-aged and elderly people aged 45 years and above were selected as the study subjects. Activities of daily living（ADL） and instrumental activities of daily living（IADL） scales were used to determine disability. The situation and degree of disability in middle-aged and elderly people were considered as dependent variables，and independent variables were selected from three aspects of general demographic characteristics，health evaluation and lifestyle according to CHARLS data questionnaire. Binary and multivariate Logistic regression analyses were conducted to analyze the factors affecting the disability and degree of disability of middle-aged and elderly people in eastern, central and western regions of China. Results Comparison of the rate and degree of disability among middle-aged and elderly people in eastern，central and western regions showed statistically significant differences（2 =143.014，P<0.001；2 =136.356，P<0.001）. Mild disability predominated among middle-aged and elderly people in eastern，central and western regions； the difference was statistically significant when comparing the age composition of middle-aged and elderly people with mild and severe disability in eastern，central and western regions（P<0.05）. There were commonalities and characteristics in the influencing factors of disability and disability degree in the three regions. Age，education level and self-rated health status were the common influencing factors of disability in middle-aged and elderly people in eastern，central and western regions（P<0.05）. Gender and physical disability were the independent influencing factors for the development of disability in middle-aged and elderly people in eastern China （P<0.05）. The risk of disability in middle-aged and elderly people in females was 86.0% higher than that in males（OR=1.860， 95%CI=1.036 to 3.338）. Marital status and combining with chronic disease were the independent influencing factors for disability in middle-aged and elderly people（P<0.05）. Residence，brain damage/intellectual impairment were the independent influencing factors for disability among middle-aged and elderly people in western China（P<0.05）. Conclusion Targeted prevention and treatment strategies should be formulated focusing on regional differences in the disability status of middle-aged and elderly people and influencing factors. Publicity and education should be strengthened，the construction of primary care and community health management systems should be improved，regionalized medical services and rehabilitation guidance should be provided，so as to reduce the degree of disability among middle-aged and elderly people，prevent the deepening of disability，and alleviate regional disparities in disability.
|4. 1990—2019 年中国龋病的疾病负担现状及变化趋势研究||2023-11-29|