独居与非独居老年人健康衰退轨迹与死亡风险差异——医疗保险的调节作用

摘要/Abstract

摘要： 在重度老龄化社会来临之际,剖析老年人健康状态的影响因素,将预防关口前移,对于实现健康中国战略具有重要意义。基于2005—2018年中国老年健康影响因素追踪调查（CLHLS）数据,应用基组轨迹模型识别中国独居、非独居老年人健康衰退的轨迹模式,并采用Frailty因子的Gompertz风险回归模型检验不同健康衰退组群轨迹模式对老年人死亡风险的影响。结论显示,第一,中国老年人健康衰退轨迹呈现低起点快速下降型、中起点快速下降型和高起点平稳下降型。第二,健康衰退速率与死亡风险呈现一致的排序关系。低起点快速下降型中的独居老年人死亡风险最高。其中,独居老年人健康衰退轨迹和死亡风险存在城乡差异。第三,医疗保险减缓了不同健康衰退轨迹中独居老年人的死亡风险,且调节强度存在城乡差异。因此,政府应着力构建区域动态健康监测体系,实时跟踪评估老年人群健康发展趋势,深化养老服务与医疗资源整合协同,并完善多层次医疗保障体系,切实提升老年人健康服务质效与可及性。

关键词: 独居老年人, 健康衰退, 死亡风险, 医疗保险, 人口老龄化

Abstract: Based on the data from the China Geriatric Health Longitudinal Study (CLHLS) from 2005 to 2018, this study applies the baseline trajectory model to identify the trajectory patterns of health decline among elderly people living alone and not living alone in China. The Gompertz risk regression model with Frailty factor is also used to test the impact of different trajectory patterns of health decline groups on the mortality risk of elderly people. The conclusion shows that firstly, the health decline trajectory of elderly people in China presents a low starting point rapid decline pattern, a medium starting point rapid decline pattern, and a high starting point stable decline pattern. Secondly, there is a consistent ranking relationship between the rate of health decline and the risk of death. Elderly people living alone have the highest risk of death in the low starting point rapid decline type. Among them, there are urban-rural differences in the health decline trajectory and mortality risk of elderly people living alone. Thirdly, medical insurance has reduced the mortality risk of elderly people living alone in different health decline trajectories, and the intensity of regulation varies between urban and rural areas. Therefore, the government should focus on building a regional dynamic health monitoring system, track and evaluate the health development trends of the elderly population in real time, deepen the integration and coordination of elderly care services and medical resources, and improve the multi-level medical security system to effectively enhance the quality, efficiency, and accessibility of elderly health services.

Key words: elderly people living alone, healthy decline, mortality risk, medical insurance, population aging

中图分类号:

F842.6

李安琪. 独居与非独居老年人健康衰退轨迹与死亡风险差异——医疗保险的调节作用[J]. 江西财经大学学报, 2026, 0(4): 138-149.

Li An-qi. The Differences in Health Decline Trajectory and Mortality Risk between Elderly People Living Alone and Those not Living Alone: the Moderating Effect of Medical Insurance[J]. Journal of Jiangxi University of Finance and Economics, 2026, 0(4): 138-149.

参考文献

[1] 陈飞, 陈琳. 健全养老服务体系:社区养老支持与老龄健康[J]. 财经研究, 2023, (2): 49-63.
[2] 丁继红, 董旭达. 我国城乡老龄健康: 子女的作用有多大?——基于CHNS数据的实证研究[J]. 南开经济研究, 2017, (5): 60-76.
[3] 高健, 李华, 徐英奇. 商业医疗保险能缓解城乡居民医保家庭“因病致贫”吗?——大病冲击下的经验证据[J]. 江西财经大学学报, 2019, (5): 81-91.
[4] 何文. 社会医疗保险制度的健康绩效及其区域异质性[J]. 江西财经大学学报, 2022, (1): 87-97.
[5] 蒋俊佳, 陈瑛玮, 许吉祥, 等. 基于群组轨迹模型的健康老龄化指数变化轨迹分类及影响因素分析[J]. 老年医学与保健, 2022, (5): 973-977.
[6] 李安琪, 吴瑞君, 张晓杰. 婚姻教育匹配与老年人死亡风险——认知能力的中介作用[J]. 社会发展研究, 2023, (3): 83-104.
[7] 陆杰华, 郭冉. 病态状态压缩还是病态状态扩展?——1998-2014年老年人健康指标长期变化趋势探究[J]. 人口与发展, 2019, (6): 76-86.
[8] 穆滢潭, 龙飞, 原新. 中国老年人健康老龄化的城乡差异及其变迁趋势——基于生命历程和健康公平视角的分析[J]. 人口研究, 2023, (4): 82-97.
[9] 王金水, 许琪. 居住安排、代际支持与老年人的主观福祉[J]. 社会发展研究, 2020, (3): 193-208.
[10] 王增文, 胡国恒. “补供方”抑或“补需方”?政府医疗投入路径对健康产出的效应分析[J]. 当代财经, 2021, (11): 41-51.
[11] 叶欣, 王鑫峰, 王延赏. 城乡医疗保险整合对农村中老年人健康结局的影响及潜在机制——基于中国健康与养老追踪调查的证据[J]. 人口与发展, 2025, (3): 26-39.
[12] 袁妙彧, 程琳, 向楠. 独居老人临终期的居住安排变化对死亡质量的影响——基于CLHLS 2011、2014、2018三期数据的实证分析[J]. 人口与发展, 2025, (3): 122-131.
[13] 张文娟, 付敏. 2010—2020年中国老年人口的健康状况及其变化趋势——基于人口普查和抽样调查数据的分析[J]. 中国人口科学, 2022, (5): 17-31.
[14] 张文娟, 王东京. 中国老年人临终前生活自理能力的衰退轨迹[J]. 人口学刊, 2020, (1): 70-84.
[15] 张鑫鑫, 佟岩, 英玉波, 等. 我国老年人成功老龄化现状与死亡风险关系研究[J]. 现代预防医学, 2021, (23): 4335-4339+4348.
[16] 张郁杨, 袁微. 养老金能否降低农村老人的健康风险?——兼论社区养老服务的协同作用[J]. 财经研究, 2022, (11): 49-63.
[17] 赵立新. 独居老人居家安全的社会协同机制研究[J]. 人口学刊, 2024, (4): 86-98.
[18] Abell J G, Steptoe A.Why is living alone in older age related to increased mortality risk? A longitudinal cohort study[J]. Age and Ageing, 2021, 50(6): 2019-2024.
[19] de la Fuente J, Caballero F F, Sánchez-Niubó A, et al. Determinants of health trajectories in England and the United States: an approach to identify different patterns of healthy aging[J]. The Journals of Gerontology: Series A, 2018, 73(11): 1512-1518.
[20] Gu D N, Zhang Z, Zeng Y.Access to healthcare services makes a difference in healthy longevity among older Chinese adults[J]. Social Science & Medicine, 2009, 68(2): 210-219.
[21] Han E J, Song M K, Lee Y.The 10-year multi-morbidity trajectory and mortality risk in older people with long-term care needs[J]. Arch Gerontol Geriatr, 2022, 103: 104775.
[22] Hsu H C, Jones B L.Multiple trajectories of successful aging of older and younger cohorts[J]. The Gerontologist, 2012, 52(6): 843-856.
[23] Hu X, Gu S, Sun X, et al.Cognitive ageing trajectories and mortality of Chinese oldest-old[J]. Archives of Gerontology and Geriatrics, 2019, 82: 81-87.
[24] McCabe E L, Larson M G, Lunetta K L, et al. Association of an index of healthy aging with incident cardiovascular disease and mortality in a community-based sample of older adults[J]. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 2016, 71(12): 1695-1701.
[25] Nagin D S, Jones B L, Passos V L, et al.Group-based multi-trajectory modeling[J]. Statistical Methods in Medical research, 2018, 27(7): 2015-2023.
[26] Porell F W, Miltiades H B.Access to care and functional status change among aged Medicare beneficiaries[J]. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2001, 56(2): S69-S83.
[27] Yu R, Wong M, Chong K C, et al.Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: An age-period-cohort analysis[J]. Age and Ageing, 2018, 47(2): 254-261.
[28] Zeng Y.Toward deeper research and better policy for healthy aging-using the unique data of Chinese Longitudinal Healthy Longevity Survey[J]. China Economic Journal, 2012, 5(2-3): 131-149.
[29] Zhang H, Zhu Y, Hao M, et al.The modified healthy ageing index is associated with mortality and disability: The Rugao Longevity and Ageing Study[J]. Gerontology, 2021, 67(5): 572-580.