Lu Liyong, Chen Ting, Li Sicheng, Lan Tianjiao
Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China.
SSM Popul Health. 2025 Jan 4;29:101749. doi: 10.1016/j.ssmph.2025.101749. eCollection 2025 Mar.
This study examines the association between family economic decision-making power and survival outcomes among older adults.
Data were drawn from the China Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2018. Family economic decision-making power was assessed based on participants' self-reported influence over household financial matters, categorized as: "making decisions on almost all household expenditures", "deciding on non-essential spending", "only deciding on personal expenditures", and "having no decision-making power over household spending". Survival status and date of death were determined through interviews with close family members during each survey round. Cox proportional hazards regression models were used to analyze the relationship between family economic decision-making authority and survival outcomes among older adults using longitudinal follow-up data. Subgroup analyses were conducted to identify vulnerable populations.
The study included 10,443 older adults, of whom 5606 (53.68%) died during the follow-up period, with a median survival time of 7 years. Compared to those with full decision-making authority, the hazard ratios (95% CI) were 1.02 (0.87-1.20) for those with authority over non-essential spending, 1.22 (1.07-1.38) for those with authority over personal spending, and 1.24 (1.04-1.47) for those with no decision-making power. The impact of low decision-making authority on survival was modified by factors such as gender, occupation before age 60, household economic status, experience of child loss, and physical labor.
Low family economic decision-making power is associated with an increased risk of mortality. Promoting active participation in financial decisions may enhance health outcomes. However, the study is limited by its focus on Chinese data, challenges in establishing causal relationships, and the measurement of decision-making power at a single point in time.
本研究探讨老年人家庭经济决策权与生存结局之间的关联。
数据取自2005年至2018年的中国健康与养老追踪调查（CLHLS）。家庭经济决策权根据参与者自我报告的对家庭财务事务的影响进行评估，分为：“几乎对所有家庭支出做出决策”、“决定非必要支出”、“仅决定个人支出”以及“对家庭支出没有决策权”。通过在每次调查轮次中与亲密家庭成员进行访谈来确定生存状况和死亡日期。使用Cox比例风险回归模型，利用纵向随访数据分析老年人家庭经济决策权威与生存结局之间的关系。进行亚组分析以识别弱势群体。
该研究纳入了10443名老年人，其中5606人（53.68%）在随访期间死亡，中位生存时间为7年。与拥有完全决策权的人相比，对非必要支出有决策权的人的风险比（95%CI）为1.02（0.87 - 1.20），对个人支出有决策权的人为1.22（1.07 - 1.38），没有决策权的人为1.24（1.04 - 1.47）。低决策权对生存的影响因性别、60岁前职业、家庭经济状况、失子经历和体力劳动等因素而有所改变。
家庭经济决策权低与死亡风险增加相关。促进积极参与财务决策可能会改善健康结局。然而，本研究受到其对中国数据的关注、建立因果关系的挑战以及单一时间点决策权测量的限制。
