Article(id=1240375118673801640, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310118, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1696867200000, receivedDateStr=2023-10-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658073347, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658073347, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658073347, creator=13701087609, updateTime=1773658073347, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1036, endPage=1043, ext={EN=ArticleExt(id=1240375119986618837, articleId=1240375118673801640, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impacts of health checkups on the utilization of inpatient services for patients with chronic diseases, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the impact of health checkups on the utilization of inpatient services for patients with chronic diseases to promote the utilization of health checkups and alleviate the burden of hospitalization.

Methods

Utilizing data from four waves of the China Health and Retirement Longitudinal Study conducted in 2011, 2013, 2015, and 2018, this study employed coarsened exact matching (CEM) and the difference-in-difference(DID)and BK method to analyze the impact of health checkups on the utilization of inpatient services for patients with chronic diseases, along with examining its influencing mechanisms.

Results

Health checkups were found to increase the probability of hospitalization by 34.4% (β=0.344, 95% CI: 0.132-0.556) and reduce hospitalization costs by 3 145 yuan (β=-3 145.470, 95% CI: -6 074.532--216.407) for patients with chronic diseases. Exercise was identified as mediating the association between health checkups and hospitalization (β=-0.184, 95% CI: -0.323--0.045). Age was observed to negatively moderate the relationship between health checkups and hospitalization (β=-0.531, 95% CI: -0.804--0.258). Patients with multiple chronic diseases and groups with health insurance were more significantly affected by health checkups.

Conclusion

Health checkups increase the likelihood of hospitalization and reduce hospitalization costs for individuals with chronic diseases. Promoting healthy lifestyles among those with chronic conditions is essential, with a specific focus on groups susceptible to health risk shocks.

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目的

探究健康体检对慢性病患者住院服务利用的影响,为促进健康体检利用和缓解住院负担提供参考。

方法

本研究使用了2011年、2013年、2015年和2018年四期的中国健康与养老追踪调查数据,采用粗糙化精确匹配、双重差分框架和BK法分析健康体检对慢性病患者住院服务利用的影响及其影响机制。

结果

健康体检使慢性病患者的住院概率提高了34.4%(β=0.344,95% CI:0.132~0.556),住院费用降低了约3 145元(β=-3 145.470,95% CI:-6 074.532~-216.407)。运动在健康体检与住院之间起到中介作用(β=-0.184,95% CI:-0.323~-0.045)。年龄负向调节了健康体检与住院的关系(β=-0.531,95% CI:-0.804~-0.258)。多重慢性病患者和有医疗保险群体受健康体检的影响更大。

结论

健康体检能够提高慢性病患者的住院概率,并降低住院费用。应促进慢性病患者养成健康的生活方式,关注易受健康风险冲击的群体。

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苏敏,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=whzPlR7pGexeDztpa3pv/A==, magXml=gw30bcGR93BvJt9EzeoqOw==, pdfUrl=null, pdf=7SfoTUrTY+ueKR4BuJdhrw==, pdfFileSize=1007928, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=pgE9PERfXNRPPh6KrubMFQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=lI1/NC+VO9irK7qH4b/kZQ==, mapNumber=null, authorCompany=null, fund=null, authors=

李东旭(1994—),男,博士在读,研究方向:卫生政策和卫生体系

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李东旭(1994—),男,博士在读,研究方向:卫生政策和卫生体系

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李东旭(1994—),男,博士在读,研究方向:卫生政策和卫生体系

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keyword=住院费用)], refs=[Reference(id=1240746305920758486, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, doi=null, pmid=null, pmcid=null, year=2023, volume=36, issue=12, pageStart=73, pageEnd=78, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=邓鹏鸿, 陈鸣声, journalName=医学与社会, refType=null, unstructuredReference=邓鹏鸿,陈鸣声.我国慢性病患者卫生服务利用研究现状及热点分析[J].医学与社会202336(12):73-78., articleTitle=我国慢性病患者卫生服务利用研究现状及热点分析, refAbstract=null), Reference(id=1240746306038199005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, doi=null, pmid=null, pmcid=null, year=2023, volume=36, issue=12, pageStart=73, pageEnd=78, url=null, language=null, rfNumber=[1], rfOrder=1, authorNames=Deng PH, Chen MS, journalName=Medicine and Society, refType=null, unstructuredReference=Deng PH, Chen MS. 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Modern Preventive Medicine, 2021, 48(4): 710-713., articleTitle=Research progress on intervention effect of physical exercise on chronic diseases, refAbstract=null), Reference(id=1240746309586580427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, doi=null, pmid=null, pmcid=null, year=2022, volume=49, issue=5, pageStart=839, pageEnd=844, url=null, language=null, rfNumber=[20], rfOrder=36, authorNames=王文龙, 虎昭言, 高保锴, journalName=现代预防医学, refType=null, unstructuredReference=王文龙,虎昭言,高保锴,等.中国西部山区慢性病患者卫生服务利用现状及其影响因素分析——基于Anderson模型的宁夏南部山区为例[J].现代预防医学202249(5):839-844., articleTitle=中国西部山区慢性病患者卫生服务利用现状及其影响因素分析——基于Anderson模型的宁夏南部山区为例, refAbstract=null), Reference(id=1240746309695632336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, doi=null, pmid=null, pmcid=null, year=2022, volume=49, issue=5, pageStart=839, pageEnd=844, url=null, language=null, rfNumber=[20], rfOrder=37, authorNames=Wang WL, Hu ZY, Gao BK, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Wang WL, Hu ZY, Gao BK, et al. Current status and influencing factors of health services for patients with chronic diseases in western mountainous areas of China——Based on the Anderson model, taking the mountainous area of southern Ningxia as an example[J]. Modern Preventive Medicine, 2022, 49(5): 839-844., articleTitle=Current status and influencing factors of health services for patients with chronic diseases in western mountainous areas of China——Based on the Anderson model, taking the mountainous area of southern Ningxia as an example, refAbstract=null)], funds=[Fund(id=1240746305505522354, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, awardId=72164031, language=CN, fundingSource=国家自然科学基金项目(72164031), fundOrder=null, country=null), Fund(id=1240746305656517305, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, awardId=72204128, language=CN, fundingSource=国家自然科学基金项目(72204128), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746300682072312, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, xref=null, ext=[AuthorCompanyExt(id=1240746300690460921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, companyId=1240746300682072312, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Management, Inner Mongolia University, Hohhot, Inner Mongolia 010070, China), AuthorCompanyExt(id=1240746300698849530, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, companyId=1240746300682072312, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=内蒙古大学公共管理学院,内蒙古 呼和浩特 010070)])], figs=[ArticleFig(id=1240746303395787257, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Fig.1, caption=Sample processing flowchart, figureFileSmall=kN6SNZ7ygZ+DDuxXcWWR0w==, figureFileBig=L/qhbrQl8UOWmkDuqLtzXA==, tableContent=null), ArticleFig(id=1240746303634862602, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=图1, caption=样本处理流程图, figureFileSmall=kN6SNZ7ygZ+DDuxXcWWR0w==, figureFileBig=L/qhbrQl8UOWmkDuqLtzXA==, tableContent=null), ArticleFig(id=1240746303777468952, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Fig.2, caption=Parallel trend test results of the impact of health checkups on the utilization of inpatient services for patients with chronic diseases, figureFileSmall=dsdDbqueBStj0aWRXuNNyA==, figureFileBig=w179aXX27ORn2m0RxQOigg==, tableContent=null), ArticleFig(id=1240746303865549342, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=图2, caption=健康体检对慢性病患者住院服务利用影响的平行趋势检验结果, figureFileSmall=dsdDbqueBStj0aWRXuNNyA==, figureFileBig=w179aXX27ORn2m0RxQOigg==, tableContent=null), ArticleFig(id=1240746304008155693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Fig.3, caption=Heterogeneity analysis of the impact of h health checkups on the utilization of inpatient services for patients with chronic diseases, figureFileSmall=wMT+dPKSuAofC50Gn8G2RQ==, figureFileBig=maCl0os6pOrG5wVnzOyUkg==, tableContent=null), ArticleFig(id=1240746304121401915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=图3, caption=健康体检对慢性病患者住院服务利用影响的异质性分析

注:图A和图B分别表示健康体检对是否住院和住院费用的异质性分析。

, figureFileSmall=wMT+dPKSuAofC50Gn8G2RQ==, figureFileBig=maCl0os6pOrG5wVnzOyUkg==, tableContent=null), ArticleFig(id=1240746304238842435, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Table 1, caption=

Descriptive statistics of major variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计对照组实验组t/χ2P
2015
住院4.0090.045
5 034(88.0)3 074(88.7)1 960(87.0)
685(12.0)391(11.3)294(13.0)
住院费用8 674.663±13 895.1178 222.689±12 307.9659 271.269±15 751.069-0.9440.346
2018
住院56.595<0.001
4 647(81.3)2 924(84.4)1 723(76.4)
1 072(18.7)541(15.6)531(23.6)
住院费用9 745.779±15 128.03810 803.202±16 287.7878 677.226±13 792.9352.1760.030
性别0.5990.439
3 105(54.3)1 867(53.9)1 238(54.9)
2 614(45.7)1 598(46.1)1 016(45.1)
居住地24.071<0.001
农村4 004(70.0)2 509(72.4)1 495(66.3)
城市1 715(30.0)956(27.6)759(33.7)
年龄165.741<0.001
≤60岁2 925(51.1)2 010(58.0)915(40.6)
60岁以上2 794(48.9)1 455(42.0)1 339(59.4)
教育程度6.2830.012
小学及以下5 284(92.4)3 226(93.1)2 058(91.3)
初中及以上435(7.6)239(6.9)196(8.7)
婚姻状况5.0660.024
其他763(13.3)434(12.5)329(14.6)
已婚4 956(86.7)3 031(87.5)1 925(85.4)
个人收入2 668.494±8 848.0602 496.421±8 019.9102 933.015±9 984.243-1.8240.068
多重慢性病18.385<0.001
2 470(43.2)1 575(45.5)895(39.7)
3 249(56.8)1 890(54.5)1 359(60.3)
医疗保险类型33.391<0.001
城镇职工医疗保险355(6.2)167(4.8)188(8.3)
城镇居民医疗保险240(4.2)137(4.0)103(4.6)
新型农村合作医疗保险4 470(78.2)2 751(79.4)1 719(76.3)
城乡居民医疗保险101(1.8)57(1.6)44(2.0)
其他553(9.7)353(10.2)200(8.9)
样本量5 719(100.0)3 465(60.6)2 254(39.4)
), ArticleFig(id=1240746304352088653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=表1, caption=

主要变量的描述性统计

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计对照组实验组t/χ2P
2015
住院4.0090.045
5 034(88.0)3 074(88.7)1 960(87.0)
685(12.0)391(11.3)294(13.0)
住院费用8 674.663±13 895.1178 222.689±12 307.9659 271.269±15 751.069-0.9440.346
2018
住院56.595<0.001
4 647(81.3)2 924(84.4)1 723(76.4)
1 072(18.7)541(15.6)531(23.6)
住院费用9 745.779±15 128.03810 803.202±16 287.7878 677.226±13 792.9352.1760.030
性别0.5990.439
3 105(54.3)1 867(53.9)1 238(54.9)
2 614(45.7)1 598(46.1)1 016(45.1)
居住地24.071<0.001
农村4 004(70.0)2 509(72.4)1 495(66.3)
城市1 715(30.0)956(27.6)759(33.7)
年龄165.741<0.001
≤60岁2 925(51.1)2 010(58.0)915(40.6)
60岁以上2 794(48.9)1 455(42.0)1 339(59.4)
教育程度6.2830.012
小学及以下5 284(92.4)3 226(93.1)2 058(91.3)
初中及以上435(7.6)239(6.9)196(8.7)
婚姻状况5.0660.024
其他763(13.3)434(12.5)329(14.6)
已婚4 956(86.7)3 031(87.5)1 925(85.4)
个人收入2 668.494±8 848.0602 496.421±8 019.9102 933.015±9 984.243-1.8240.068
多重慢性病18.385<0.001
2 470(43.2)1 575(45.5)895(39.7)
3 249(56.8)1 890(54.5)1 359(60.3)
医疗保险类型33.391<0.001
城镇职工医疗保险355(6.2)167(4.8)188(8.3)
城镇居民医疗保险240(4.2)137(4.0)103(4.6)
新型农村合作医疗保险4 470(78.2)2 751(79.4)1 719(76.3)
城乡居民医疗保险101(1.8)57(1.6)44(2.0)
其他553(9.7)353(10.2)200(8.9)
样本量5 719(100.0)3 465(60.6)2 254(39.4)
), ArticleFig(id=1240746304456946263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Table 2, caption=

Regression results of the impact of health checkups on the utilization of inpatient services for patients with chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
变量DID估计结果
住院住院费用
βP95% CIβP95% CI
DID0.3440.0010.132~0.556-3 198.7800.032-6 127.482~-270.079
YEAR0.3410.0000.198~0.4842 748.0140.005828.569~4 667.460
TREAT0.0600.479-0.106~0.2251 057.1480.350-1 160.219~3 274.514
性别(对照组:女性)0.0040.947-0.105~0.1121 450.0870.059-52.811~2 952.986
居住地(对照组:农村)0.0780.213-0.045~0.20186.4240.918-1 566.703~1 739.551
年龄(对照组:60岁)0.2350.0000.118~0.352-878.9280.255-2 394.452~636.595
教育程度(对照组:小学及以下)0.1340.205-0.074~0.342-1 306.1840.285-3 702.165~1 089.797
婚姻状况(对照组:其他)-0.1530.034-0.295~-0.0121 425.1300.114-340.392~3 190.652
个人收入(对数处理)-0.0510.000-0.069~-0.033-343.8600.002-560.775~-126.944
多重慢性病(对照组:无=0)0.5380.0000.427~0.649-385.9150.641-2 006.766~1 234.936
医疗保险类型
城镇职工医疗保险0.6090.0000.307~0.9114 147.6270.015815.887~7 479.368
城镇居民医疗保险0.4330.0140.088~0.7782 421.5820.239-1 610.660~6 453.824
新型农村合作医疗保险0.3570.0030.123~0.5921 939.0920.127-552.439~4 430.623
城乡居民医疗保险0.2910.060-0.013~0.5951 747.4650.322-1 713.198~5 208.128
地区效应控制控制
R2/Pseudo R20.0410.031
P<0.001<0.001
N11 4381 593
变量CEM-DID
住院住院费用
βP95% CIβP95% CI
DID0.4210.0000.194~0.649-3 353.8420.045-6 631.356~-76.328
YEAR0.3290.0000.174~0.4832 704.8460.013580.143~4 829.549
TREAT0.0330.713-0.144~0.2101 365.1740.286-1 142.930~3 873.277
性别(对照组:女性)0.0120.837-0.104~0.1291 552.6750.075-157.491~3 262.842
居住地(对照组:农村)0.0540.435-0.082~0.191412.3860.669-1 479.141~2 303.914
年龄(对照组:60岁)0.2270.0000.100~0.354-1 141.7870.190-2 849.950~566.375
教育程度(对照组:小学及以下)0.0700.626-0.210~0.350-1 227.9070.439-4 339.759~1 883.945
婚姻状况(对照组:其他)-0.1990.014-0.357~-0.040940.4620.386-1 186.223~3 067.147
个人收入(对数处理)-0.0640.000-0.086~-0.041-291.7470.093-631.858~48.363
多重慢性病(对照组:无=0)0.5050.0000.386~0.625-161.0380.861-1 970.975~1 648.899
医疗保险类型
城镇职工医疗保险0.7200.0000.367~1.0742 593.2620.188-1 268.780~6 455.305
城镇居民医疗保险0.5550.0090.140~0.9692 540.1350.373-3 046.464~8 126.735
新型农村合作医疗保险0.4710.0010.198~0.7451 052.9990.510-2 082.143~4 188.141
城乡居民医疗保险0.3510.051-0.001~0.7031 596.7910.490-2 938.472~6 132.055
地区效应控制控制
R2/Pseudo R20.0410.026
P<0.001<0.001
N11 4381 388
), ArticleFig(id=1240746304561803869, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=表2, caption=

健康体检对慢性病患者住院服务利用影响的回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量DID估计结果
住院住院费用
βP95% CIβP95% CI
DID0.3440.0010.132~0.556-3 198.7800.032-6 127.482~-270.079
YEAR0.3410.0000.198~0.4842 748.0140.005828.569~4 667.460
TREAT0.0600.479-0.106~0.2251 057.1480.350-1 160.219~3 274.514
性别(对照组:女性)0.0040.947-0.105~0.1121 450.0870.059-52.811~2 952.986
居住地(对照组:农村)0.0780.213-0.045~0.20186.4240.918-1 566.703~1 739.551
年龄(对照组:60岁)0.2350.0000.118~0.352-878.9280.255-2 394.452~636.595
教育程度(对照组:小学及以下)0.1340.205-0.074~0.342-1 306.1840.285-3 702.165~1 089.797
婚姻状况(对照组:其他)-0.1530.034-0.295~-0.0121 425.1300.114-340.392~3 190.652
个人收入(对数处理)-0.0510.000-0.069~-0.033-343.8600.002-560.775~-126.944
多重慢性病(对照组:无=0)0.5380.0000.427~0.649-385.9150.641-2 006.766~1 234.936
医疗保险类型
城镇职工医疗保险0.6090.0000.307~0.9114 147.6270.015815.887~7 479.368
城镇居民医疗保险0.4330.0140.088~0.7782 421.5820.239-1 610.660~6 453.824
新型农村合作医疗保险0.3570.0030.123~0.5921 939.0920.127-552.439~4 430.623
城乡居民医疗保险0.2910.060-0.013~0.5951 747.4650.322-1 713.198~5 208.128
地区效应控制控制
R2/Pseudo R20.0410.031
P<0.001<0.001
N11 4381 593
变量CEM-DID
住院住院费用
βP95% CIβP95% CI
DID0.4210.0000.194~0.649-3 353.8420.045-6 631.356~-76.328
YEAR0.3290.0000.174~0.4832 704.8460.013580.143~4 829.549
TREAT0.0330.713-0.144~0.2101 365.1740.286-1 142.930~3 873.277
性别(对照组:女性)0.0120.837-0.104~0.1291 552.6750.075-157.491~3 262.842
居住地(对照组:农村)0.0540.435-0.082~0.191412.3860.669-1 479.141~2 303.914
年龄(对照组:60岁)0.2270.0000.100~0.354-1 141.7870.190-2 849.950~566.375
教育程度(对照组:小学及以下)0.0700.626-0.210~0.350-1 227.9070.439-4 339.759~1 883.945
婚姻状况(对照组:其他)-0.1990.014-0.357~-0.040940.4620.386-1 186.223~3 067.147
个人收入(对数处理)-0.0640.000-0.086~-0.041-291.7470.093-631.858~48.363
多重慢性病(对照组:无=0)0.5050.0000.386~0.625-161.0380.861-1 970.975~1 648.899
医疗保险类型
城镇职工医疗保险0.7200.0000.367~1.0742 593.2620.188-1 268.780~6 455.305
城镇居民医疗保险0.5550.0090.140~0.9692 540.1350.373-3 046.464~8 126.735
新型农村合作医疗保险0.4710.0010.198~0.7451 052.9990.510-2 082.143~4 188.141
城乡居民医疗保险0.3510.051-0.001~0.7031 596.7910.490-2 938.472~6 132.055
地区效应控制控制
R2/Pseudo R20.0410.026
P<0.001<0.001
N11 4381 388
), ArticleFig(id=1240746304670855785, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Table 3, caption=

Regression results of the impact of health checkups on mediating variables

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟饮酒运动
βP95% CIβP95% CIβP95% CI
DID-0.0070.972-0.419~0.4040.0630.535-0.136~0.2620.2330.0320.020~0.447
控制变量控制控制控制
地区效应控制控制控制
R2/Pseudo R20.5410.1750.198
P<0.001<0.001<0.001
N9 9489 9489 948
社交睡眠时间
βP95% CIβP95% CI
DID0.2570.0020.094~0.4200.0110.889-0.144~0.166
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0230.029
P<0.001<0.001
N9 9489 948
), ArticleFig(id=1240746304796684917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=表3, caption=

健康体检对中介变量影响的回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟饮酒运动
βP95% CIβP95% CIβP95% CI
DID-0.0070.972-0.419~0.4040.0630.535-0.136~0.2620.2330.0320.020~0.447
控制变量控制控制控制
地区效应控制控制控制
R2/Pseudo R20.5410.1750.198
P<0.001<0.001<0.001
N9 9489 9489 948
社交睡眠时间
βP95% CIβP95% CI
DID0.2570.0020.094~0.4200.0110.889-0.144~0.166
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0230.029
P<0.001<0.001
N9 9489 948
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Analysis of the mediating effect of health checkups on the utilization of inpatient services for patients with chronic diseases

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住院
βP95% CIβP95% CI
DID0.4260.0000.199~0.6540.4240.0000.197~0.652
社交-0.0820.156-0.195~0.031
运动-0.1840.010-0.323~-0.045
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0420.042
P<0.001<0.001
N9 9489 948
住院费用
βP95% CIβP95% CI
DID-3 348.0380.046-6 640.855~-55.222
社交-181.8880.827-1 817.690~1 453.914
运动-1 954.8650.067-4 046.510~136.781
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0260.028
P<0.001<0.001
N1 3881 388
), ArticleFig(id=1240746305018983047, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=表4, caption=

健康体检对慢性病患者住院服务利用影响的中介效应分析

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住院
βP95% CIβP95% CI
DID0.4260.0000.199~0.6540.4240.0000.197~0.652
社交-0.0820.156-0.195~0.031
运动-0.1840.010-0.323~-0.045
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0420.042
P<0.001<0.001
N9 9489 948
住院费用
βP95% CIβP95% CI
DID-3 348.0380.046-6 640.855~-55.222
社交-181.8880.827-1 817.690~1 453.914
运动-1 954.8650.067-4 046.510~136.781
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0260.028
P<0.001<0.001
N1 3881 388
), ArticleFig(id=1240746305136423572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=EN, label=Table 5, caption=

Analysis of the moderating effect of health checkups on the utilization of inpatient services for patients with chronic diseases

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住院住院费用
βP95% CIβP95% CI
DID0.8300.0000.523~1.136-5 431.8220.005-9 223.835~-1 639.809
DID*年龄-0.5310.000-0.804~-0.2582 751.6650.106-589.782~6 093.113
年龄0.3510.0000.209~0.493-1 909.6200.075-4 014.645~195.405
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0430.027
P<0.001<0.001
N9 9481 388
), ArticleFig(id=1240746305220309658, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118673801640, language=CN, label=表5, caption=

健康体检对慢性病患者住院服务利用的调节效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
住院住院费用
βP95% CIβP95% CI
DID0.8300.0000.523~1.136-5 431.8220.005-9 223.835~-1 639.809
DID*年龄-0.5310.000-0.804~-0.2582 751.6650.106-589.782~6 093.113
年龄0.3510.0000.209~0.493-1 909.6200.075-4 014.645~195.405
控制变量控制控制
地区效应控制控制
R2/Pseudo R20.0430.027
P<0.001<0.001
N9 9481 388
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健康体检对慢性病患者住院服务利用的影响分析
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李东旭 , 张苇乐 , 李汇波 , 刘泽霖 , 苏敏
现代预防医学 | 卫生政策与管理 2024,51(6): 1036-1043
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现代预防医学 | 卫生政策与管理 2024, 51(6): 1036-1043
健康体检对慢性病患者住院服务利用的影响分析
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李东旭, 张苇乐, 李汇波, 刘泽霖, 苏敏
作者信息
  • 内蒙古大学公共管理学院,内蒙古 呼和浩特 010070
  • 李东旭(1994—),男,博士在读,研究方向:卫生政策和卫生体系

通讯作者:

苏敏,E-mail:
Impacts of health checkups on the utilization of inpatient services for patients with chronic diseases
Dong-xu LI, Wei-le ZHANG, Hui-bo LI, Ze-lin LIU, Min SU
Affiliations
  • School of Public Management, Inner Mongolia University, Hohhot, Inner Mongolia 010070, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202310118
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目的

探究健康体检对慢性病患者住院服务利用的影响,为促进健康体检利用和缓解住院负担提供参考。

方法

本研究使用了2011年、2013年、2015年和2018年四期的中国健康与养老追踪调查数据,采用粗糙化精确匹配、双重差分框架和BK法分析健康体检对慢性病患者住院服务利用的影响及其影响机制。

结果

健康体检使慢性病患者的住院概率提高了34.4%(β=0.344,95% CI:0.132~0.556),住院费用降低了约3 145元(β=-3 145.470,95% CI:-6 074.532~-216.407)。运动在健康体检与住院之间起到中介作用(β=-0.184,95% CI:-0.323~-0.045)。年龄负向调节了健康体检与住院的关系(β=-0.531,95% CI:-0.804~-0.258)。多重慢性病患者和有医疗保险群体受健康体检的影响更大。

结论

健康体检能够提高慢性病患者的住院概率,并降低住院费用。应促进慢性病患者养成健康的生活方式,关注易受健康风险冲击的群体。

健康体检  /  慢性病  /  住院  /  住院费用
Objective

To explore the impact of health checkups on the utilization of inpatient services for patients with chronic diseases to promote the utilization of health checkups and alleviate the burden of hospitalization.

Methods

Utilizing data from four waves of the China Health and Retirement Longitudinal Study conducted in 2011, 2013, 2015, and 2018, this study employed coarsened exact matching (CEM) and the difference-in-difference(DID)and BK method to analyze the impact of health checkups on the utilization of inpatient services for patients with chronic diseases, along with examining its influencing mechanisms.

Results

Health checkups were found to increase the probability of hospitalization by 34.4% (β=0.344, 95% CI: 0.132-0.556) and reduce hospitalization costs by 3 145 yuan (β=-3 145.470, 95% CI: -6 074.532--216.407) for patients with chronic diseases. Exercise was identified as mediating the association between health checkups and hospitalization (β=-0.184, 95% CI: -0.323--0.045). Age was observed to negatively moderate the relationship between health checkups and hospitalization (β=-0.531, 95% CI: -0.804--0.258). Patients with multiple chronic diseases and groups with health insurance were more significantly affected by health checkups.

Conclusion

Health checkups increase the likelihood of hospitalization and reduce hospitalization costs for individuals with chronic diseases. Promoting healthy lifestyles among those with chronic conditions is essential, with a specific focus on groups susceptible to health risk shocks.

Health checkups  /  Chronic diseases  /  Hospitalization  /  Hospitalization costs
李东旭, 张苇乐, 李汇波, 刘泽霖, 苏敏. 健康体检对慢性病患者住院服务利用的影响分析. 现代预防医学, 2024 , 51 (6) : 1036 -1043 . DOI: 10.20043/j.cnki.MPM.202310118
Dong-xu LI, Wei-le ZHANG, Hui-bo LI, Ze-lin LIU, Min SU. Impacts of health checkups on the utilization of inpatient services for patients with chronic diseases[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1036 -1043 . DOI: 10.20043/j.cnki.MPM.202310118
随着我国老龄化程度日益加深和疾病谱转变,慢性非传染性疾病(简称慢性病)的发病率和危害逐渐增加。慢性病是影响中国居民健康的高危因素[1]。《健康中国行动(2019-2030年)》显示,近1.8亿老年人患有慢性病,患有一种及以上慢性病的比例高达75%,慢性病导致的负担占总疾病负担的70%以上[2]。在此背景下,如何减轻慢性病患者的医疗负担成为备受关注的重要议题。
健康体检是落实健康预防和健康管理的重要内容,也是降低医疗负担的有效途径。当前对健康体检作用的研究集中在提高医疗服务利用率[3-4]和对医疗费用的影响等方面[5-6]。然而,关于健康体检对慢性病患者住院服务利用的影响缺少探讨,且已有研究多基于截面数据分析或预测[7-8]。因此,本研究通过使用四期面板数据,采用粗糙化精确匹配(Coarsened Exact Matching,CEM)和双重差分框架(Difference-in-difference,DID)分析健康体检对慢性病患者的住院服务利用的影响,以期为完善健康体检相关政策和减轻慢性病患者医疗负担提供参考。
本研究数据来源于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)。CHARLS旨在收集一套代表中国45岁及以上中老年人家庭和个人的高质量微观数据,CHARLS全国基线调查于2011年开展,覆盖150个县级单位,450个村级单位,约1万户家庭中的1.7万人。该数据包含社会人口学特征、健康状况与行为、健康体检与医疗服务利用等信息[9],因此本研究使用CHARLS来分析健康体检对慢性病患者住院服务利用的影响具有代表性。
为考察健康体检对慢性病患者住院服务利用的影响,本文采用双重差分模型如下:
在式(1)中,yit是解释变量,即个体i在第t期的住院利用状况。DIDit是本文的解释变量,由Yi*Yt计算得来,系数β1表示健康体检对慢性病患者住院服务利用的影响效应。Ti表示对照组和实验组,如果样本在2018年前未参与健康体检,则为对照组,赋值为0;2015年前没做过健康体检,并在2015—2018年之间参与健康体检,则为实验组,赋值为1。Yt则表示时间变量,如果样本处于健康体检实施前的基期(2015年),则赋值为0,如果处于健康体检后的实验期(2018年),赋值为1。Xit表示影响住院服务利用的其他控制变量,εit是误差项。
同时,本研究使用CEM法进行了稳健性检验[10]。CEM法通过减少对照组和实验组之间变量的不平衡性,以增强两组群体的可比性,检验回归结果是否稳健。本研究采用了多因素回归分析,模型中对相关的协变量已经加以控制,为进一步控制对照组和实验组的个体差异,本研究选择了性别、居住地、年龄、教育程度、婚姻状况、个人收入、是否患有多重慢性病、医疗保险类型和地区等变量进行了CEM匹配。
使用双重差分法需要满足平行趋势检验[11],即在健康体检实施之前,对照组和实验组应该在变量的表现上保持一致。本研究采用事件研究法进行平衡趋势检验[12-13]。生成年份虚拟变量与实验组虚拟变量的交互项,将这些交互项作为解释变量进行回归。交互项的系数反映的即是在特定年份对照组和实验组之间是否住院和住院费用的差异。本研究在2015年和2018年两期数据的基础上,加入2011年和2013年两期数据进行平行趋势检验。
健康体检具有疾病的早预防功能,有助于形成健康的生活方式,这可能影响了慢性病患者的健康状况和住院服务利用状况。为了进一步探索健康体检与住院服务利用之间的作用机制,使用行为生活方式作为中介变量,进行中介效应分析。根据BK法[14],首先,检验健康体检对住院服务利用的影响;其次,检验健康体检对中介变量即行为生活方式的影响,如果不显著则停止检验;最后,检验健康体检和中介变量对住院服务利用的影响。因此,构建以下中介效应模型:
在式(3)(4)中,Zit是中介变量,即个体i在第t期的行为生活方式,包括吸烟、饮酒、运动、社交和睡眠时间。
不同年龄段可能受到健康体检的影响可能不同。为了精确识别健康体检对住院服务利用的影响,对模型进行进一步优化,使用年龄变量进行调节效应分析。本文在式(1)基础上,将其扩展为:
此外,健康体检对住院服务利用的影响可能受到样本的个体状况影响。多重慢性病患者面临更大的健康风险,并且,是否有医疗保险则反映了对疾病负担的承载能力。因此本研究通过异质性分析,进一步探索健康体检对不同群体住院服务利用的影响。
本研究通过CHARLS调查中“过去一年内,您住过院吗?”这个问题来判断慢性病患者是否利用了住院服务。通过“最近一次住院一共花了多少钱?”来判断慢性病患者的住院费用。
本研究通过CHARLS调查中“您吸过烟吗?”“在过去的一年,您喝酒吗?” “您通常每周花了多少时间做这些活动?”“您过去一个月是否进行了下列社交活动?”“过去一个月内,您平均每天晚上真正睡着的时间大约是几小时?”来衡量患者吸烟、饮酒、运动、社交和睡眠时间等行为生活方式。其中,吸烟、饮酒、运动和社交为分类变量(否=0,是=1),睡眠时间为连续变量。
本研究控制了居住地、性别、年龄、教育程度、婚姻状况、个人收入、是否患有多重慢性病、医疗保险类型和地区的固定效应。
在本研究中,分类变量采用频数和百分比描述,连续变量采用均数±标准差进行描述。当被解释变量为是否住院时采用logistic模型,当被解释变量为住院费用时采用OLS模型。所有数据均采用STATA 15.1软件进行统计分析,所有假设检验的显著性水平均为0.05。单因素分析采用t/χ2检验。
以2015年和2018年CHARLS两期数据为研究样本,将2018年前未做健康体检的样本设定为对照组,将2015年前没做过健康体检,并在2015—2018年期间参与健康体检设定为实验组。研究样本限定为患有慢性病的群体,分析健康体检对慢性病患者住院医疗服务利用的影响。最终纳入5 719人,其中对照组样本为3 465人,实验组样本为 2 254人,两期总样本量为11 438个。在CEM后得到4 974人,其中对照组样本为 3 000人,实验组样本为1 974人,两期总样本量为9 948个。样本纳入过程详见图1
表1可知,2015年中,住院人数为685人,占比12.0%,住院费用平均为8 675元。2018年住院人数为1 072人,占比18.7%,住院费用平均为9 746元。样本中,女性和男性分别占54.3%和45.7%,农村和城市样本分别占70.0%和30.0%,年龄小于等于60岁和大于60岁的样本分别占51.1%和48.9%,小学及以下学历和初中及以上学历分别占92.4%和7.6%,已婚样本和其他样本分别占86.7%和13.3%,平均个人收入约为2 668元,患有多重慢性病的比例占56.8%。参加新型农村合作医疗保险的比例占78.2%。详见表1
表2汇报了健康体检对慢性病患者住院服务利用的回归结果。双重差分结果显示,健康体检使住院概率提高了34.4%(β=0.344,95% CI:0.132~0.556),住院费用降低了约3 145元(β=-3 145.470,95% CI:-6 074.532~-216.407)。在进行了粗糙化精确匹配后,健康体检使住院概率提高了42.1%(β=0.421,95% CI:0.194~0.649),住院费用降低了约3 354元(β=-3 353.842,95% CI:-6 631.356~-76.328),回归结果保持稳健。
图2根据年份虚拟变量与实验组虚拟变量的交互项系数及其95%置信区间绘制而成。在没有进行健康体检之前,Pre_2(前2期)、Pre_1(前1期)和current(0期)的系数不显著,表明对照组和实验组之间是否住院和住院费用不存在明显的变动趋势差异,而在Post_1(后1期),即健康体检之后系数显著,说明健康体检提高了慢性病患者的住院概率,降低了住院费用,满足平行趋势检验。
表3汇报了健康体检对中介变量的回归分析结果。结果显示,健康体检使运动概率提高了23.3%(β=0.233,95% CI:0.020~0.447),社交概率提高了25.7%(β=0.257,95% CI:0.094~0.420)。运动(P<0.05)和社交(P<0.01)可以作为中介变量,而吸烟、饮酒和睡眠时间未在5%的统计水平上有显著意义,不能作为中介变量。
表3的基础上,表4进一步分析运动和社交的中介作用。结果显示,运动使住院概率降低了18.4%(β=-0.184,95% CI:-0.323~-0.045),即健康体检通过提高运动概率,降低了住院可能性。运动使住院费用降低了约1 955元(β=-1 954.865,95% CI:-4 046.510~136.781),仅在10%的统计水平上有显著意义,即健康体检通过提高运动概率,降低住院费用。而社交则在中介效应分析中5%的统计水平上没有显著意义。
表5汇报了健康体检对慢性病患者住院服务利用影响的调节效应分析。结果显示,年龄越大,健康体检对住院的影响越低(β=-0.531,95% CI:-0.804~-0.258)。
图3汇报了健康体检对慢性病患者住院服务利用的异质性分析结果。结果显示,相比于没有多重慢性病的样本,有多重慢性病的群体是否住院和住院费用受健康体检的影响更大。相比于没有医疗保险,有医疗保险的群体是否住院受健康体检的影响更大。
本研究结果显示,健康体检显著提高了慢性病患者的住院概率,并显著降低了住院费用。已有研究表明,健康体检提高了慢性病患者自我管理的意识[15]。健康体检有助于疾病的早治疗,因此提高了慢性病患者的住院概率。此外,健康体检是降低医疗费用的有效方式。提高体检频率,有利于增加对健康状况的关注,并有效减少或预防慢性疾病的发生,进而减少医疗费用。此前的研究结果显示,慢性病预防性健康体检项目每投入1元钱,能节约11.72~14.27元的直接医疗费用[7]。本研究通过追踪个人健康体检行为,发现了健康体检能够降低慢性病患者的住院服务负担。健康体检有助于疾病早发现、早诊断[16],减轻了疾病恶化和经济负担加重的风险,从而降低了住院服务费用。
本研究结果显示,健康体检通过提高慢性病患者的运动概率,降低了住院概率和住院费用。健康体检有助于普及健康知识,对健康行为做出专业指导[17],有助于慢性病患者形成更加健康的行为生活方式。有效的预防工作能够降低公众面临的健康风险概率,从而降低健康服务需求[18]。运动对控制慢性病有明显效果,有助于提高患者的生存率和身体机能[19]。通过健康体检,促进了慢性病患者的运动行为,有效改善行为生活方式和身体素质,进而减少住院服务利用。
本研究结果显示,健康体检对年龄较小、患有多重慢性病和有医疗保险的群体影响更大。这可能是由于年龄较小的群体的健康意识和素养更强,更容易利用体检。多重慢性病患者面临更大的健康风险,定期健康体检是及时发现其健康风险、促进住院服务利用的重要方式。此外,医疗保险提高了参保人群的医疗服务利用水平[20]。健康体检有助于发现疾病问题,医疗保险则对慢性病患者的住院服务利用起到兜底作用。
这项研究发现健康体检对慢性病患者住院服务利用有显著影响,并提示要进一步完善慢性病患者健康体检内容,提高健康体检参与率,增强慢性病患者健康素养,培养健康的生活方式,并关注易受健康风险冲击的群体,以促进慢性病患者身体健康和缓解医疗负担。但是,本研究仍有一定局限性。第一,由于数据限制,本研究采用了四期数据,未来仍需要长期数据来追踪健康体检对慢性病患者住院服务利用的动态影响与持续影响。第二,CHARLS数据调查的是45岁及以上的群体,而随着慢性病的年轻化,对年轻群体的健康体检情况仍需进一步关注。
  • 国家自然科学基金项目(72164031)
  • 国家自然科学基金项目(72204128)
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doi: 10.20043/j.cnki.MPM.202310118
  • 接收时间:2023-10-10
  • 首发时间:2026-03-16
  • 出版时间:2024-03-25
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  • 收稿日期:2023-10-10
基金
国家自然科学基金项目(72164031)
国家自然科学基金项目(72204128)
作者信息
    内蒙古大学公共管理学院,内蒙古 呼和浩特 010070

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苏敏,E-mail:
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202310118
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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