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Article(id=1241329574043251154, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412467, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735142400000, receivedDateStr=2024-12-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633239, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633239, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633239, creator=13701087609, updateTime=1773885633239, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2425, endPage=2430, ext={EN=ArticleExt(id=1241329574378795482, articleId=1241329574043251154, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of influencing factors and urban-rural differences in health impairment among empty-nest elderly in China based on Fairlie decomposition, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influencing factors and urban-rural differences in health impairment among empty-nest elderly in China, providing references for reducing health risks and optimizing allocation of elderly care resources.

Methods

Using data from 4 025 empty-nest elderly in the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018), binary logistic regression was employed to identify influencing factors, and Fairlie decomposition was used to analyze urban-rural differences.

Results

The prevalence of health impairment was 10.58%.Logistic regression showed significant associations with age, physical examination, pension insurance, ≥2 chronic diseases, outdoor activities, and access to healthcare/life care services. Fairlie decomposition revealed a total urban-rural difference of -0.0606, with 44.06% explained by observable factors. The main contributors were: number of chronic diseases (28.22%), healthcare access (19.64%), outdoor activities (-14.36%), and physical examination (7.76%).

Conclusion

Urban empty-nest elderly show higher health impairment rates than rural counterparts. Priority should be given to addressing disparities in chronic disease management, healthcare access, outdoor activities, and health examination between urban and rural areas.

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目的

分析我国空巢老人健康受损的影响因素及其城乡差异，为避免空巢老人健康损害风险、实现养老资源的合理配置提供参考依据。

方法

利用中国老年健康影响因素跟踪调查（CLHLS 2018）数据库中的4 025名空巢老人相关数据，采用二元logistic回归分析我国空巢老人健康受损的影响因素，Fairlie分解法对空巢老人健康受损进行城乡差异分析。

结果

我国空巢老人健康受损率为10.58%；二元logistic回归结果显示，年龄、体检、养老保险、慢性病数量≥2种、参加户外活动、提供医疗保健和生活照料是我国空巢老人健康受损的影响因素；Fairlie分解分析结果显示，空巢老人健康受损的城乡总差异为-0.060 6，可解释部分贡献率为44.06%，空巢老人健康受损城乡差异的影响因素按贡献率大小依次为慢性病数量（28.22%）、医疗保健（19.64%）、户外活动（-14.36%）、体检（7.76%）。

结论

我国城市空巢老人健康受损率高于农村，需要重点关注慢性病数量、医疗保健、户外活动、体检所导致的城乡差异。

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孙晓杰，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=wxO3PJdtd9gMc8aa3RMPTA==, magXml=3jIFcGujabPCeVyPt9eR1Q==, pdfUrl=null, pdf=1zDTSxPISAwdKo9XfPHemw==, pdfFileSize=648659, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=g5MH3rQKalxTSP1z1rVdzQ==, mapNumber=null, authorCompany=null, fund=null, authors=

王银（1991—），女，硕士，讲师，研究方向：社会因素与健康、卫生服务与政策方面的研究工作

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王银（1991—），女，硕士，讲师，研究方向：社会因素与健康、卫生服务与政策方面的研究工作

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王银（1991—），女，硕士，讲师，研究方向：社会因素与健康、卫生服务与政策方面的研究工作

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(In Chinese), articleTitle=Research on gender differences and influencing mechanisms of selfcare ability in elderly People in China, refAbstract=null)], funds=[Fund(id=1241329766079451959, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, awardId=2021-NW-002, language=CN, fundingSource=2021年度宁夏卫生健康系统科研课题(2021-NW-002), fundOrder=null, country=null), Fund(id=1241329766192698176, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, awardId=XZ2023022, language=CN, fundingSource=宁夏医科大学校级科研项目(XZ2023022), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329762585596442, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, xref=1., ext=[AuthorCompanyExt(id=1241329762598179357, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, companyId=1241329762585596442, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Humanities and Management, Ningxia Medical University, Yinchuan, Ningxia 750004, China), AuthorCompanyExt(id=1241329762686259748, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, companyId=1241329762585596442, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.宁夏医科大学人文与管理学院，宁夏 银川 750004)]), AuthorCompany(id=1241329762849837611, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, xref=2., ext=[AuthorCompanyExt(id=1241329762862420526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, companyId=1241329762849837611, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.山东大学齐鲁医学院公共卫生学院社会医学与卫生事业管理学系，山东 济南 250012)])], figs=[ArticleFig(id=1241329764905046747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=EN, label=Table 1, caption=

Univariate analysis of impaired health in empty nesters

, figureFileSmall=null, figureFileBig=null, tableContent=
变量农村城市
调查人数（%）健康受损人数（%）χ2值P值调查人数（%）健康受损人数（%）χ2值P值
性别1.6840.1940.1890.664
男1 437114（7.9）766115（15.0）
女1 264118（9.3）55879（14.2）
年龄（岁）170.645<0.001191.819<0.001
65～741 04542（4.0）45918（3.9）
75～8492553（5.7）46246（10.0）
85～9454582（15）29073（25.2）
≥9518655（29.6）11357（50.4）
受教育程度30.029<0.00116.4880.001
文盲1 105133（12.0）21049（23.3）
小学1 19376（6.4）38657（14.8）
中学29620（6.8）27433（12.0）
高中及以上1073（2.8）45455（12.1）
婚姻状况17.470<0.00133.798<0.001
非在婚74391（12.2）37789（23.6）
在婚1 958141（7.2）947105（11.1）
吸烟史0.4430.5060.5070.476
无1 680149（8.9）896127（14.2）
有1 02183（8.1）42867（15.7）
饮酒史4.4070.0369.1050.003
无1 861174(9.3）960158(16.5）
有84058（6.9）36436（9.9）
自评经济3.8180.1484.9400.085
困难33837(10.9）5112(23.5）
一般1 959167(8.5）877118(13.5）
富裕40428(6.9）39664(16.2）
体检28.480<0.00122.393<0.001
否59283(14.0）32674(22.7）
是2 109149(7.1）998120(12.0）
养老保险0.5120.47411.6610.001
无20120(10.0）21147(22.3）
有2 500212(8.5）1 113147(13.2）
子女照料7.7270.0053.6910.055
否1 560114（7.3）852113（13.3）
是1 141118（10.3）47281（17.2）
慢性病数量（种）14.8590.0018.7380.013
098469（7.0）28739（13.6）
198175（7.6）40244（10.9）
≥273688（12.0）635111（17.5）
户外活动111.516<0.001132.064<0.001
不参加623117（18.8）316108（34.2）
有时1 47994（6.4）59864（10.7）
几乎每天59921（3.5）41022（5.4）
生活照料0.4400.50718.050<0.001
否2 321196（8.4）1 046131（12.5）
是38036（9.5）27863（22.7）
医疗保健3.9600.0482.5970.107
否60964（10.5）55892（16.5）
是2 092168（8.0）766102（13.3）
精神慰藉0.1080.7420.0020.998
否1 218107（8.8）58085（14.7）
是1 483125（8.4）744109（14.7）
), ArticleFig(id=1241329765047653094, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=CN, label=表1, caption=

空巢老人健康受损单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量农村城市
调查人数（%）健康受损人数（%）χ2值P值调查人数（%）健康受损人数（%）χ2值P值
性别1.6840.1940.1890.664
男1 437114（7.9）766115（15.0）
女1 264118（9.3）55879（14.2）
年龄（岁）170.645<0.001191.819<0.001
65～741 04542（4.0）45918（3.9）
75～8492553（5.7）46246（10.0）
85～9454582（15）29073（25.2）
≥9518655（29.6）11357（50.4）
受教育程度30.029<0.00116.4880.001
文盲1 105133（12.0）21049（23.3）
小学1 19376（6.4）38657（14.8）
中学29620（6.8）27433（12.0）
高中及以上1073（2.8）45455（12.1）
婚姻状况17.470<0.00133.798<0.001
非在婚74391（12.2）37789（23.6）
在婚1 958141（7.2）947105（11.1）
吸烟史0.4430.5060.5070.476
无1 680149（8.9）896127（14.2）
有1 02183（8.1）42867（15.7）
饮酒史4.4070.0369.1050.003
无1 861174(9.3）960158(16.5）
有84058（6.9）36436（9.9）
自评经济3.8180.1484.9400.085
困难33837(10.9）5112(23.5）
一般1 959167(8.5）877118(13.5）
富裕40428(6.9）39664(16.2）
体检28.480<0.00122.393<0.001
否59283(14.0）32674(22.7）
是2 109149(7.1）998120(12.0）
养老保险0.5120.47411.6610.001
无20120(10.0）21147(22.3）
有2 500212(8.5）1 113147(13.2）
子女照料7.7270.0053.6910.055
否1 560114（7.3）852113（13.3）
是1 141118（10.3）47281（17.2）
慢性病数量（种）14.8590.0018.7380.013
098469（7.0）28739（13.6）
198175（7.6）40244（10.9）
≥273688（12.0）635111（17.5）
户外活动111.516<0.001132.064<0.001
不参加623117（18.8）316108（34.2）
有时1 47994（6.4）59864（10.7）
几乎每天59921（3.5）41022（5.4）
生活照料0.4400.50718.050<0.001
否2 321196（8.4）1 046131（12.5）
是38036（9.5）27863（22.7）
医疗保健3.9600.0482.5970.107
否60964（10.5）55892（16.5）
是2 092168（8.0）766102（13.3）
精神慰藉0.1080.7420.0020.998
否1 218107（8.8）58085（14.7）
是1 483125（8.4）744109（14.7）
), ArticleFig(id=1241329765186065133, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=EN, label=Table 2, caption=

Binary logistic regression results of influencing health impairment of rural empty-nesters

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照β Waldχ2值P值OR值(95%CI)
年龄（岁）65～74
75～840.2900.2201.7360.1881.336（0.868～2.056）
85～941.3840.22637.627<0.0013.989(2.564～6.207)
≥952.1780.28060.578<0.0018.828(5.101～15.278)
受教育程度文盲
小学-0.2050.1671.5130.2190.814(0.587～1.129)
中学0.2590.2780.8700.3511.296(0.752～2.232)
高中及以上-0.9120.6112.2290.1350.402(0.121～1.330)
婚姻状况非在婚
在婚0.1140.1890.3630.5471.120(0.774～1.622)
饮酒史无
有-0.2920.1702.9440.0860.747(0.535～1.042)
体检否
是-0.4350.1617.3490.0070.647(0.472～0.886)
子女照料否
是-0.2390.1731.9200.1660.787(0.561～1.104)
慢性病数量（种）0
10.2710.1862.1290.1451.311(0.911～1.888)
≥20.9980.18628.830<0.0012.712(1.884～3.904)
户外活动不参加
有时-0.9870.15838.977<0.0010.373(0.273～0.508)
几乎每天-1.5470.25436.999<0.0010.213(0.129～0.351)
医疗保健否
是-0.3430.1684.1720.0410.709(0.510～0.986)
), ArticleFig(id=1241329765332865788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=CN, label=表2, caption=

农村空巢老人健康受损影响因素的二元logistic回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照β Waldχ2值P值OR值(95%CI)
年龄（岁）65～74
75～840.2900.2201.7360.1881.336（0.868～2.056）
85～941.3840.22637.627<0.0013.989(2.564～6.207)
≥952.1780.28060.578<0.0018.828(5.101～15.278)
受教育程度文盲
小学-0.2050.1671.5130.2190.814(0.587～1.129)
中学0.2590.2780.8700.3511.296(0.752～2.232)
高中及以上-0.9120.6112.2290.1350.402(0.121～1.330)
婚姻状况非在婚
在婚0.1140.1890.3630.5471.120(0.774～1.622)
饮酒史无
有-0.2920.1702.9440.0860.747(0.535～1.042)
体检否
是-0.4350.1617.3490.0070.647(0.472～0.886)
子女照料否
是-0.2390.1731.9200.1660.787(0.561～1.104)
慢性病数量（种）0
10.2710.1862.1290.1451.311(0.911～1.888)
≥20.9980.18628.830<0.0012.712(1.884～3.904)
户外活动不参加
有时-0.9870.15838.977<0.0010.373(0.273～0.508)
几乎每天-1.5470.25436.999<0.0010.213(0.129～0.351)
医疗保健否
是-0.3430.1684.1720.0410.709(0.510～0.986)
), ArticleFig(id=1241329765446112006, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=EN, label=Table 3, caption=

Binary logistic regression results of influencing factors of health impairment among urban empty-nesters

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照β Waldχ2 值P值OR值(95%CI）
年龄（岁）65-74
75～840.7690.2966.7530.0092.158(1.208～3.855）
85～941.6970.29832.340<0.0015.455(3.040～9.788）
≥952.6110.34656.884<0.00113.606(6.904～26.814）
受教育程度文盲
小学-0.1340.2500.2880.5920.875(0.536～1.427）
中学-0.0550.2920.0350.8510.947(0.535～1.677）
高中及以上-0.0540.2640.0410.8390.948(0.565～1.591）
婚姻状况非在婚
在婚-0.0560.2010.0780.7810.945(0.637～1.403）
饮酒史无
有-0.4150.2243.4400.0640.660(0.426～1.024）
体检否
是-0.2300.1931.4170.2340.795(0.544～1.160）
养老保险无
有-0.6790.2179.8090.0020.507(0.331～0.775）
慢性病数量（种）0
1-0.1240.2710.2110.6460.883(0.520～1.501）
≥20.6020.2446.0720.0141.825(1.131～2.945）
户外活动不参加
有时-0.9560.19723.506<0.0010.384(0.261～0.566）
几乎每天-1.6110.27035.638<0.0010.200(0.118～0.339）
生活照料否
是0.5330.2007.0750.0081.704(1.150～2.523）
), ArticleFig(id=1241329765601301264, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=CN, label=表3, caption=

城市空巢老人健康受损影响因素的二元logistic回归结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照β Waldχ2 值P值OR值(95%CI）
年龄（岁）65-74
75～840.7690.2966.7530.0092.158(1.208～3.855）
85～941.6970.29832.340<0.0015.455(3.040～9.788）
≥952.6110.34656.884<0.00113.606(6.904～26.814）
受教育程度文盲
小学-0.1340.2500.2880.5920.875(0.536～1.427）
中学-0.0550.2920.0350.8510.947(0.535～1.677）
高中及以上-0.0540.2640.0410.8390.948(0.565～1.591）
婚姻状况非在婚
在婚-0.0560.2010.0780.7810.945(0.637～1.403）
饮酒史无
有-0.4150.2243.4400.0640.660(0.426～1.024）
体检否
是-0.2300.1931.4170.2340.795(0.544～1.160）
养老保险无
有-0.6790.2179.8090.0020.507(0.331～0.775）
慢性病数量（种）0
1-0.1240.2710.2110.6460.883(0.520～1.501）
≥20.6020.2446.0720.0141.825(1.131～2.945）
户外活动不参加
有时-0.9560.19723.506<0.0010.384(0.261～0.566）
几乎每天-1.6110.27035.638<0.0010.200(0.118～0.339）
生活照料否
是0.5330.2007.0750.0081.704(1.150～2.523）
), ArticleFig(id=1241329765697770263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=EN, label=Table 4, caption=

Fairlie decomposition of urban-rural differences in impaired health among empty-nesters

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β贡献率（%）排序P值
总差异-0.060 6100.00
可解释部分-0.026 744.06
不可解释部分-0.033 955.94
年龄-0.002 54.1350.078
体检-0.004 77.7640.016
养老保险-0.000 30.5070.883
慢性病数量-0.017 128.221<0.001
户外活动0.008 7-14.363<0.001
医疗保健-0.011 919.642<0.001
生活照料0.001 1-1.8260.606
), ArticleFig(id=1241329765852959525, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329574043251154, language=CN, label=表4, caption=

空巢老人健康受损城乡差异的fairlie分解

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β贡献率（%）排序P值
总差异-0.060 6100.00
可解释部分-0.026 744.06
不可解释部分-0.033 955.94
年龄-0.002 54.1350.078
体检-0.004 77.7640.016
养老保险-0.000 30.5070.883
慢性病数量-0.017 128.221<0.001
户外活动0.008 7-14.363<0.001
医疗保健-0.011 919.642<0.001
生活照料0.001 1-1.8260.606
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基于Fairlie分解的我国空巢老人健康受损的影响因素及其城乡差异分析
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王银 1, 2 , 孙晓杰 1
现代预防医学 | 基层卫生服务 2025,52(13): 2425-2430
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现代预防医学 | 基层卫生服务 2025, 52(13): 2425-2430
基于Fairlie分解的我国空巢老人健康受损的影响因素及其城乡差异分析
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王银1, 2, 孙晓杰1
作者信息
  • 1.宁夏医科大学人文与管理学院，宁夏 银川 750004
  • 2.山东大学齐鲁医学院公共卫生学院社会医学与卫生事业管理学系，山东 济南 250012

    • 王银（1991—），女，硕士，讲师，研究方向：社会因素与健康、卫生服务与政策方面的研究工作

通讯作者:

孙晓杰，E-mail:
Analysis of influencing factors and urban-rural differences in health impairment among empty-nest elderly in China based on Fairlie decomposition
Yin WANG1, 2, Xiao-jie SUN1
Affiliations
  • School of Humanities and Management, Ningxia Medical University, Yinchuan, Ningxia 750004, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202412467
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摘要
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目的

分析我国空巢老人健康受损的影响因素及其城乡差异，为避免空巢老人健康损害风险、实现养老资源的合理配置提供参考依据。

方法

利用中国老年健康影响因素跟踪调查（CLHLS 2018）数据库中的4 025名空巢老人相关数据，采用二元logistic回归分析我国空巢老人健康受损的影响因素，Fairlie分解法对空巢老人健康受损进行城乡差异分析。

结果

我国空巢老人健康受损率为10.58%；二元logistic回归结果显示，年龄、体检、养老保险、慢性病数量≥2种、参加户外活动、提供医疗保健和生活照料是我国空巢老人健康受损的影响因素；Fairlie分解分析结果显示，空巢老人健康受损的城乡总差异为-0.060 6，可解释部分贡献率为44.06%，空巢老人健康受损城乡差异的影响因素按贡献率大小依次为慢性病数量（28.22%）、医疗保健（19.64%）、户外活动（-14.36%）、体检（7.76%）。

结论

我国城市空巢老人健康受损率高于农村，需要重点关注慢性病数量、医疗保健、户外活动、体检所导致的城乡差异。

空巢老人  /  健康受损  /  影响因素  /  Fairlie分解法
Objective

To analyze the influencing factors and urban-rural differences in health impairment among empty-nest elderly in China, providing references for reducing health risks and optimizing allocation of elderly care resources.

Methods

Using data from 4 025 empty-nest elderly in the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018), binary logistic regression was employed to identify influencing factors, and Fairlie decomposition was used to analyze urban-rural differences.

Results

The prevalence of health impairment was 10.58%.Logistic regression showed significant associations with age, physical examination, pension insurance, ≥2 chronic diseases, outdoor activities, and access to healthcare/life care services. Fairlie decomposition revealed a total urban-rural difference of -0.0606, with 44.06% explained by observable factors. The main contributors were: number of chronic diseases (28.22%), healthcare access (19.64%), outdoor activities (-14.36%), and physical examination (7.76%).

Conclusion

Urban empty-nest elderly show higher health impairment rates than rural counterparts. Priority should be given to addressing disparities in chronic disease management, healthcare access, outdoor activities, and health examination between urban and rural areas.

Empty-nest elderly  /  Health impairment  /  Influencing factors  /  Fairlie decomposition
王银, 孙晓杰. 基于Fairlie分解的我国空巢老人健康受损的影响因素及其城乡差异分析. 现代预防医学, 2025 , 52 (13) : 2425 -2430 . DOI: 10.20043/j.cnki.MPM.202412467
Yin WANG, Xiao-jie SUN. Analysis of influencing factors and urban-rural differences in health impairment among empty-nest elderly in China based on Fairlie decomposition[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2425 -2430 . DOI: 10.20043/j.cnki.MPM.202412467
正文
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当前，老龄化问题和人口结构的变化已成为我国面临的重要社会挑战，尤其伴随着城镇化、工业化进程的加快，子女异地就业现象突出，催化了空巢老人数量的不断增长，使得空巢家庭成为我国家庭结构的重要形态[1]，因此关注空巢老人健康问题已成为推进健康老龄化的重要议题。完好的健康状态是空巢老人保持健康生活和较高生命质量的基础保障[2]，不仅可以减轻家庭和社会医疗经济负担，同时也能节约家庭照料资源、医疗卫生服务资源等，因此学者们积极探索应对空巢老人健康风险的对策与路径。目前，由于城乡二元经济结构长期存在，导致老年人在养老资源、就医环境、公共基础设施等方面呈现出较大城乡差异[3]，长期以往，使城乡老年人健康水平出现较大差距，阻碍了健康公平性的有序发展，这有悖于健康中国战略提出的意义。然而已有研究探讨老年人健康公平性相关问题时，多采用传统logistic回归分析影响因素，且分析层面单一，未充分考虑城乡差异这一重要维度对公平性的影响。因此，本文综合运用logistic回归和Fairlie分解法，在分析空巢老人健康影响因素的基础上，进一步剖析健康受损城乡差异的影响因素，为缩小城乡空巢老人健康差距，促进健康公平性发展提供有力支持，助力健康中国战略的顺利实施具有重要意义。对于老年人健康状态的评定，较多学者采用日常活动能力（activities of daily living，ADL）进行评估[4-6]，因此本研究采用ADL量表评定我国空巢老人健康受损情况。
1　资料与方法
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1.1　数据来源
本研究所采用数据为北京大学健康老龄与发展研究中心所组织调查的“2018年中国老年健康影响因素跟踪调查（CLHLS 2018）”存活老人数据，该项调查范围覆盖全国23个省，调查范围广泛、问卷科学合理，因此代表性强，已得到众多学者的认可和使用。2018年CLHLS存活老人问卷内容涵盖老年人基本状况、生活行为方式、ADL等方面，根据研究选题，先在数据库中剔除65岁以下老人，再剔除在养老机构及与除配偶之外其他成员居住的老人，最后对研究所需变量的缺失值和异常值进行删除，最终得到4 025个有效样本。
1.2　研究变量
1.2.1　因变量
本研究以空巢老人健康受损为因变量（0=未受损，1=受损），健康受损的评定以问卷中评价老年人ADL的量表为依据，该量表包含洗澡、穿衣、上厕所、室内活动、控制大小便和吃饭时是否需要他人帮助六项测评内容，参考以往研究对于ADL受损的界定[7]，本研究将有任何一项需要帮助则评定为健康受损。
1.2.2　自变量
综合CLHLS问卷调查内容和以往相关研究，纳入可能影响我国空巢老人健康受损及城乡差异的变量有：性别、年龄、受教育程度、婚姻状况、居住地、有无吸烟史、有无饮酒史、自评经济、是否定期体检、有无养老保险、子女是否照料、慢性病数量、户外活动、是否提供生活照料、精神慰藉和医疗保健服务16个自变量。其中，受教育程度的划分根据受教育年限，将0年界定为文盲、1～6年为小学、7～9年为初中、≥10年为高中及以上；自评经济的划分将“很困难”和“比较困难”合并为“困难”，“很富裕”和“比较富裕”合并为“富裕”；户外活动包括太极拳、广场舞、串门、与朋友交往和其他，任意一项选择“不参加”则定义为不参加，任意一项选择“每天”则定义为每天，其余则定义为有时。生活照料以社区是否提供“起居照料”衡量，医疗保健以社区是否提供“上门看病、送药”衡量，精神慰藉以社区是否提供“精神慰藉、聊天解闷”衡量。
1.3　统计学方法
应用SPSS 25.0和Stata 14.0对数据进行清洗与分析。采用检验分析空巢老人健康受损的情况；二元logistic回归分析空巢老人健康受损的影响因素；将回归结果中有统计学意义的变量纳入Fairlie分解中，分析导致空巢老人健康受损出现城乡差异的因素，检验标准α=0.05，具体步骤为：
先分别建立城市和农村空巢老人健康受损的二元logistic回归模型：
后对空巢老人健康受损的城乡差异进行分解：
其中U为城市空巢老人，R为农村空巢老人和分别为城市空巢老人和农村空巢老人健康受损的平均值为可解释部分（特征效应），表明城乡差异由空巢老人的个体特征引起为不可解释部分（系数效应），表明由城乡固有属性引起[8]。
2　结果
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2.1　空巢老人基本情况
纳入的4 024名空巢老人中，健康受损的空巢老人426人，占10.58%；男性2 203人（54.7%），女性1 822人（45.3%）；65～74岁1 504人（37.4%），75～84岁1 387人（34.5%），85～94岁835人（20.8%），≥95岁299人（7.4%）；受教育程度为文盲1 315人（32.7%），小学1 579人（39.2%），中学570人（14.2%），高中及以上561人（13.9%）；非在婚者1 120人（27.8%），在婚者2 905人（72.2%）。见表1。
2.2　空巢老人健康受损单因素分析
在单因素分析结果中，对我国农村空巢老人健康受损有影响的变量有年龄、受教育程度、婚姻状况、饮酒、体检、子女照料、慢性病数量、户外活动、医疗保健；对我国城市空巢老人健康受损有影响的变量有年龄、受教育程度、婚姻状况、饮酒、体检、养老保险、慢性病数量、户外活动、生活照料，差异有统计学意义（P<0.05）。见表1。
2.3　城乡空巢老人健康受损二元logistic回归结果
以单因素分析结果中有统计学差异的变量作为自变量，以健康受损为因变量，进行城乡老年人健康受损的二元logistic回归分析。结果得出，年龄、体检、慢性病数量、户外活动、医疗保健是农村空巢老人健康受损的影响因素，其中，年龄≥85岁、慢性病数量≥2种的农村空巢老人健康受损率高，定期体检、参加户外活动、提供医疗保健的农村空巢老人健康受损率低，见表2；年龄、养老保险、慢性病数量、户外活动、生活照料是城市空巢老人健康受损的影响因素，其中，年龄≥85岁、慢性病数量≥2种、提供生活照料的城市空巢老人健康受损率高，参加养老保险、参加户外活动的城市空巢老人健康受损率低，见表3。
2.4　空巢老人健康受损城乡差异的Fairlie分解
Fairlie分解结果显示，空巢老人健康受损的城乡总差异为-0.060 6，可解释部分为-0.026 7，贡献率为44.06%，不可解释部分为-0.033 9，占55.94%，表明空巢老人健康受损的城乡差异受到个体特征的影响，对空巢老人健康受损城乡差异有影响的特征按贡献率大小依次为慢性病数量、医疗保健、户外活动、体检，分别为28.22%、19.64%、-14.36%、7.76%，差异有统计学意义（P<0.05）；年龄、养老保险、生活照料对空巢老人健康受损的城乡差异无统计学意义。见表4。
3　讨论
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空巢老人因缺乏照料且自我养老能力低，其健康隐患甚于普通老年人，因此要精准识别影响空巢老人健康受损的因素，从而消除健康隐患，改善空巢老人健康问题。据本研究结果显示，我国空巢老人健康受损率为10.58%，健康受损受到年龄、体检、养老保险、慢性病数量、户外活动、医疗保健、生活照料的影响。随着年龄增长，老年人呈现出身体机能衰退、免疫力下降、基础病发生机率增加等特点，因此健康受损率也会随之上升。定期体检有助于老人及其家人及时发现自身存在的健康问题，从而促进老人通过利用医疗服务方式以改善健康[9]，因而使空巢老人有较低的健康受损率。养老保险作为社会保障制度的重要组成部分，能够为老年人提供稳定的收入来源，这在一定程度上可以满足老年人的基本医疗需求，因此有养老保险的空巢老人其健康受损率更低。当前，老年人易出现慢性病共存的健康问题已经成为共识[10]，而多种慢性病共存对健康的危害具有乘积效应[11]，长期的慢性病数量的累积，会使老年人发生健康损害的风险大大增高，本研究也证实了这一点，慢性病数量累积的越多，空巢老人健康受损率越高。参加户外活动的空巢老人较未参加的健康受损率低，户外活动是一种低成本的抵御健康风险的生活方式，可有效提升老人的身体素质，使健康损害风险降低，但也要注意过度活动，量力而行，保持骨骼健康。基层提供医疗保健服务是推动健康中国建设的健康基石，具有离家近、就医成本低等优势[12]，是居民发生健康风险时可及时提供救治的健康保障服务，因此社区提供医疗保健服务可有效降低空巢老人健康受损率。对空巢老人而言，生活照料会降低其健康受损率，提供照料能够使老人及其子女及时发现老人的健康状态，从而利用健康资源使空巢老人抵御健康冲击；此外，提供照料有利于缓解老人日常行动压力，避免其承担繁重的家务以降低潜在健康损害风险。
分析结果显示，城市与农村空巢老人健康受损率存在差异，居住在城市地区的空巢老人其健康受损率（14.7%）高于农村地区的空巢老人（8.6%），原因可能在于城市地区老人退出工作岗位后，经济收入稳定性下降，因此抵御日常生活和疾病经济能力的风险下降[13]。在魏蒙等人[14]的研究中发现城市地区的老年人较农村而言，更易向自理能力不健全的轨迹发展，张良文等人[15]也发现城市老年人的轻度、中度、重度失能率均高于农村老年人，但也有学者从就医便捷性、医疗资源丰富性等方面考量，得出农村地区老年人失能率高于城市地区[2]。Fairlie分解结果显示，空巢老人健康受损的城乡差异受到慢性病数量、医疗保健、户外活动和体检的影响，由于未患慢性病、社区提供医疗保健服务、参加户外活动及定期体检的空巢老人健康受损机率越低，因此为缩小城乡差异，可从以下几方面做努力：一是，有针对性地对未患慢性病空巢老人普及预防慢性病发生的知识与健康行为习惯；对已患病空巢老人及时完善健康档案并提供慢性病指导与治疗[16]，以预防慢性病进一步恶化，以此缩小城乡差异。二是，对于医疗保健服务，基层医疗机构要不断进行医疗技术上的“自我补给”，上级医疗机构也要向基层提供医疗技术的“他人供给”，从而响应居民日益增长的健康需要，改善基层医疗保健服务认可度和参与度低、利用不充分现象[17]，吸引辖区居民形成“生病下基层”的意识，尤其对于空巢老人而言，基层医疗机构是其发生健康风险时能够得到及时救治的健康壁垒，在一定程度上会降低健康受损率，缩小城乡差异。体检能够通过早期发现疾病隐患、评估健康风险等方式，帮助老年人管理自身健康，从而有效预防健康隐患、延缓疾病进展，因此社区应通过建立健康档案、优化体检流程、宣传动员等方式让老年人参与健康体检，使空巢老人从健康体检方面有效缩小城乡健康受损差异[18]。此外，户外活动会扩大空巢老人健康受损的城乡差异，如果从为空巢老人提供户外活动场所和丰富户外活动形式两方面下功夫，则会有效改善城乡空巢老人健康受损不均衡现象。
基金
收起
  • 2021年度宁夏卫生健康系统科研课题(2021-NW-002)
  • 宁夏医科大学校级科研项目(XZ2023022)
文献
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202412467
  • 接收时间：2024-12-26
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2024-12-26
基金
2021年度宁夏卫生健康系统科研课题(2021-NW-002)
宁夏医科大学校级科研项目(XZ2023022)
作者信息
    1.宁夏医科大学人文与管理学院，宁夏 银川 750004
    2.山东大学齐鲁医学院公共卫生学院社会医学与卫生事业管理学系，山东 济南 250012

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
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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