Nursing Faculty, Zhuhai Campus of Zunyi Medical University, Zhuhai, People's Republic of China.
Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Public Health, Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
Public Health. 2020 Aug;185:102-109. doi: 10.1016/j.puhe.2020.03.032. Epub 2020 Jun 27.
Chinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations.
We used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities.
Participants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures.
There were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed.
Chinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations.
中国成年人是医疗服务的最大使用者，了解当前残疾状况趋势对于规划医疗劳动力基础设施具有重要意义。我们调查了 2011 年至 2015 年期间中国成年人残疾和身体功能障碍的随时间变化趋势，并确定了与这些障碍相关的因素。
我们使用了来自中国健康与退休纵向研究（CHARLS）的全国代表性数据；CHARLS 参与者在从工作到退休的过程中每两年接受一次随访，重点关注他们的健康状况和功能能力。
纳入了 CHARLS 三个波次中年龄≥50 岁的参与者。数据收集了身体功能障碍、日常生活活动（ADL）残疾和工具性日常生活活动（IADL）残疾。使用多水平逻辑回归模型测试了 2011 年至 2015 年间调整了社会人口统计学、病史和健康措施后的变化和与障碍相关的因素。
共有 44447 名合格参与者（平均年龄：63 岁；标准差[SD]，9 岁；51%为女性）。调整后，与 2011 年调查相比，2015 年调查中报告的 ADL 或 IADL 没有显著增加。调整后，与 2011 年调查相比，2015 年调查中报告的身体功能障碍显著增加了 26%（比值比：1.26；95%置信区间，1.17 至 1.35）。与 ADL 残疾相关的因素为女性、年龄较大、受教育程度较低、前一年无饮酒、跌倒、髋部骨折、抑郁和肥胖。与 IADL 残疾相关的因素为女性、年龄较大、受教育程度较低和抑郁。
中国卫生机构应考虑为满足不断增长的需求提供足够的社区服务基础设施，以最大限度地提高独立性，特别是在人口老龄化的背景下。
