School of Geographic Sciences, Nanjing Normal University, Nanjing, China.
Department of Population Health Sciences, Department of Sociology, & Duke Clinical Research Institute, Duke University, Durham, NC, USA.
BMC Geriatr. 2020 Apr 9;20(1):129. doi: 10.1186/s12877-020-01524-9.
Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare.
A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions.
At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors.
Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
获得充分的医疗保健与较低的老年死亡率相关。然而，目前尚不清楚与获得不充分的医疗保健相比，获得充分的医疗保健可以多延长多少年寿命。
本研究使用了 2002 年至 2014 年期间中国 27794 名 65 岁以上的老年人进行的全国性纵向调查进行分析。使用多变量风险模型和寿命表技术来估计与自我报告的医疗保健获得情况（充分与不充分）相关的预期寿命差异。在调整了广泛的人口统计学因素、社会经济地位、家庭/社会支持、健康实践和健康状况后，评估了这些发现。
在 65 岁时，与报告获得不充分的医疗保健相比，充分获得医疗保健可使男性和女性以及城乡地区的预期寿命延长约 2.0-2.5 年。在 85 岁时，预期寿命的相应延长为 1.0-1.2 年。在调整了多种混杂因素后，65 岁时预期寿命的延长约为 1.1-1.5 年，85 岁时为 0.6-0.8 年。在女性中，充分获得医疗保健可使预期寿命延长 6%和 8%，分别为 65 岁和 85 岁。在男性中，预期寿命的净增长通常更大（分别为 10%和 14%），且在调整协变量后保持一致。相比之下，在没有考虑混杂因素的情况下，农村地区（65 岁时为 2.0 年，85 岁时为 1.0 年）的预期寿命增长略低于城市地区（65 岁时为 2.1 年，85 岁时为 1.1 年）。然而，在考虑了社会经济和其他因素后，农村地区（65 岁时为 1.0 年，85 岁时为 0.6 年）的预期寿命增长高于城市地区（65 岁时为 0.4 年，85 岁时为 0.2 年）。
在中国老年人中，获得充分的医疗保健与更长的预期寿命相关。这些发现对改善中国老年人口获得医疗保健的努力具有重要意义。
