School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China.
School of Pharmacy, University of Southern California, Los Angeles, California, USA.
BMJ Open. 2023 Apr 5;13(4):e070121. doi: 10.1136/bmjopen-2022-070121.
This study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.
Repeated, cross-sectional study.
This study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey.
A final analytical sample of 38 032 oldest-old individuals.
Availability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.
Of 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.
Despite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.
本研究旨在利用中国高龄老年人（年龄>80 岁）的全国性数据，考察社区家庭访视服务（CHVS）（即当地初级保健提供者提供的服务）在一段时间内的社区可及性趋势，并根据个体特征考察服务可及性的差异。
重复的、横断面研究。
本研究从 2005-2018 年中国健康长寿纵向研究中获得全国代表性数据。
最终分析样本为 38032 名高龄老年人。
CHVS 的可及性定义为在其社区内提供家庭访视服务。采用 Cochran-Armitage 检验来检验服务可及性的高龄老年人比例的线性趋势。采用加权逻辑回归模型来检验个体特征对服务可及性的变化。
在 38032 名高龄老年人中，2005 年 CHVS 的可及性为 9.7%，2008/2009 年降至 7.8%，随后持续增加，2017/2018 年增至 33.7%。农村和城市高龄老年人的变化相似。在考虑个体特征后，与同龄人相比，2017/2018 年，城市中退休前从事白领工作的居民以及居住在中国西部和东北地区的居民不太可能获得服务。2005 年或 2017/2018 年，有残疾的高龄老年人、独居的高龄老年人和收入低的高龄老年人都没有报告 CHVS 的可及性更大。
尽管过去 13 年来服务的可及性有所增加，但 CHVS 的可及性仍然存在持续的地理差异。截至 2017/2018 年，中国只有三分之一的高龄老年人报告说有服务可及性，这引起了人们对不同服务环境下最需要服务的老年人（尤其是独居或残疾的老年人）的连续性护理的关注。有必要制定国家政策和有针对性的措施，以提高 CHVS 的可及性，并减少服务可及性方面的不平等，为中国高龄老年人口提供最佳的长期护理。
