Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering), Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou, 510515, People's Republic of China.
BMC Public Health. 2023 Dec 14;23(1):2506. doi: 10.1186/s12889-023-17430-9.
Many researchers have examined the impact of social insurance on health in elderly. However, in most cases, they have only demonstrated correlational results and have not been able to determine causal effects, possibly because confounding biases have not been fully addressed. In this study, we investigated the health effects of the New Rural Pension Scheme (NRPS) on the elderly (age≥60 years old) with chronic diseases in rural areas, and to explore the causal relationship and effects of NRPS and health status.
This paper used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and applied Bayesian networks and fuzzy regression discontinuity design to conduct causal analysis. Bayesian networks were used to explore the causal directed acyclic graphs of factors related to NRPS and health status. Based on the results of Bayesian network, a fuzzy regression discontinuity design was employed to estimate the causal effect of NRPS on health status.
Among rural elderly with chronic diseases, Bayesian network mapping of causal relationships among NRPS, health status and covariates showed that age was a common cause of NRPS receipt and satisfaction with health. The results of the fuzzy regression discontinuity analysis showed that the effect of receiving NRPS on the health status was positive, but there was no statistically significant difference concerning the interval estimates. The results of the subgroup analysis with chronic obstructive pulmonary disease (COPD) and asthma indicated that the effect of NRPS receipt on the health status of elderly people with COPD was positive. There was a statistically significant effect of receiving NRPS on self-rated health description ([Formula: see text]) and health satisfaction ([Formula: see text]) in COPD population and a statistically significant effect of receiving NRPS on health satisfaction in asthma population ([Formula: see text]).
This paper has confirmed the contribution and positive causal effect of NRPS on health status in a subgroup of older adults with COPD and asthma, using the CHARLS database as evidence. Thus, Chinese government should increase the take-up rate of the NRPS to enhance their positive impact on health status of elderly people with chronic diseases in rural areas.
许多研究人员研究了社会保险对老年人健康的影响。然而，在大多数情况下，他们仅展示了相关性结果，无法确定因果效应，这可能是因为没有充分解决混杂偏差。在这项研究中，我们调查了新型农村社会养老保险（NRPS）对农村地区慢性病老年（年龄≥60 岁）的健康影响，并探讨了 NRPS 和健康状况的因果关系和影响。
本文使用了 2018 年中国健康与退休纵向研究（CHARLS）的数据，并应用贝叶斯网络和模糊回归不连续设计进行因果分析。贝叶斯网络用于探索与 NRPS 和健康状况相关因素的因果有向无环图。基于贝叶斯网络的结果，采用模糊回归不连续设计估计 NRPS 对健康状况的因果效应。
在患有慢性病的农村老年人中，NRPS、健康状况和协变量之间因果关系的贝叶斯网络映射表明，年龄是 NRPS 领取和对健康状况满意度的共同原因。模糊回归不连续分析的结果表明，领取 NRPS 对健康状况的影响是积极的，但在间隔估计方面没有统计学上的显著差异。COPD 和哮喘的亚组分析结果表明，NRPS 的领取对 COPD 老年人群健康状况的影响是积极的。在 COPD 人群中，NRPS 的领取对自我评估健康描述（[Formula: see text]）和健康满意度（[Formula: see text]）有统计学上显著的影响，在哮喘人群中，NRPS 的领取对健康满意度有统计学上显著的影响（[Formula: see text]）。
本文利用 CHARLS 数据库作为证据，证实了 NRPS 在 COPD 和哮喘亚组老年人群中对健康状况的贡献和积极的因果效应。因此，中国政府应提高 NRPS 的参保率，增强其对农村慢性病老年人群健康状况的积极影响。
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