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