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Article(id=1324077971723657504, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411301, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1731600000000, receivedDateStr=2024-11-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614388637, onlineDateStr=2026-11-02, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614388637, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614388637, creator=13701087609, updateTime=1793614388637, updator=13701087609, issue=Issue{id=1324077868950631142, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614364134, creator='13701087609', updateTime=1793614446224, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078213328142371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078213332336676, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=669, endPage=675, ext={EN=ArticleExt(id=1324077972075979041, articleId=1324077971723657504, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of inpatient health service utilization and its influencing factors among middle-aged and elderly people in rural China, 2011-2020, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the current status of inpatient health service utilization, rate and equity among middle-aged and elderly people in rural China, and to explore the contribution of each influencing factor to the inequity of inpatient health services utilization.

Methods

The concentration index and concentration curve were used to measure and show the equity of inpatient health service utilization among middle-aged and elderly people in rural areas, and used concentration index decomposition methods to conduct a decomposition analysis.

Results

From 2011 to 2020, the inpatient health service utilization rate for middle-aged and elderly people in rural China was 7.36%, 11.41%, 12.97%, 16.90%, and 21.61%, respectively. From 2011 to 2020, the concentration index of inpatient health service utilization rate among middle-aged and elderly people in rural China was 0.154 2, 0.013 4, 0.084 9, 0.043 6, and 0.050 6, respectively. Economic status, region, and age are the main factors affecting the equity of inpatient health services utilization among middle-aged and elderly people in rural areas.

Conclusion

The inpatient health service utilization is mainly concentrated among the economically well-off population. It is of great significance to reduce the inequity of inpatient health service by narrowing the gap between the rich and the poor and regional disparities, paying attention to the elderly and other groups that are vulnerable to health risks, improving the health insurance system and improving the quality of rural health service.

, authors=Dong-xu LI1, Min SU2, Wei-le ZHANG2, authorsList=Dong-xu LI, Min SU, Wei-le ZHANG, authorCompany=null, correspAuthors=Min SU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077974009553204, articleId=1324077971723657504, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2011—2020年我国农村中老年人住院服务利用情况及影响因素分析, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

了解我国农村地区中老年人住院服务利用率及公平性现状，探讨各影响因素对住院服务利用不公平的贡献程度。

方法

运用集中指数和集中曲线测量和展现农村地区中老年人住院服务利用的公平性，并利用集中指数分解法将其进行分解分析。

结果

2011年—2020年我国农村中老年人住院服务利用率分别为7.36%、11.41%、12.97%、16.90%和21.61%。2011年—2020年农村中老年人住院服务利用的集中指数分别为0.154 2、0.013 4、0.084 9、0.043 6和0.050 6。经济状况、地区和年龄是影响农村中老年人住院服务利用公平性的主要因素。

结论

住院服务利用主要集中在经济状况较好的人群中。缩小贫富差距与地区差距、关注老年群体及易受健康风险冲击的群体、完善医疗保险制度和提高农村医疗服务质量，对于降低住院服务利用不公平性具有重要意义。

, authors=李东旭1, 苏敏2, 张苇乐2, authorsList=李东旭, 苏敏, 张苇乐, authorCompany=null, correspAuthors=苏敏, authorNote=

李东旭（1994—），男，博士，讲师，研究方向：卫生政策和卫生体系

, correspAuthorsNote=
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=Y2FK2jD1gvpQCnq4KnCGlg==, magXml=epphp9VgotSmIPj30dTCYw==, pdfUrl=null, pdf=q8y/ltnzJnR8yBWoJt+z6g==, pdfFileSize=1197357, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=R6lC0VAMN03LI/xcY4UrzA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=b7cS8AY2lNnBbluo2E5SXQ==, mapNumber=null, fund=null)}, authors=[Author(id=1324077975410450747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324077975485948221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, authorId=1324077975410450747, language=EN, stringName=Dong-xu LI, firstName=Dong-xu, middleName=null, lastName=LI, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=School of Public Health, Jining Medical University, Jining, Shandong 272067, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324077975645331774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, authorId=1324077975410450747, language=CN, stringName=李东旭, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.济宁医学院公共卫生学院，山东 济宁 272067, bio={"content":"

李东旭（1994—），男，博士，讲师，研究方向：卫生政策和卫生体系

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李东旭（1994—），男，博士，讲师，研究方向：卫生政策和卫生体系

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JMIR Public Health Surveill, 2023, 9: e49603., articleTitle=Effects of the implementation of Transport-Driven poverty alleviation policy on health Care-Seeking behavior and medical expenditure among older People in rural areas: Quasi-Experimental study, refAbstract=null)], funds=[Fund(id=1324077978736533855, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, awardId=72164031, language=CN, fundingSource=国家自然科学基金项目(72164031), fundOrder=null, country=null), Fund(id=1324077978828808544, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, awardId=72204128, language=CN, fundingSource=国家自然科学基金项目(72204128), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077975251067189, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, xref=1., ext=[AuthorCompanyExt(id=1324077975263650102, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, companyId=1324077975251067189, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Jining Medical University, Jining, Shandong 272067, China), AuthorCompanyExt(id=1324077975272038711, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, companyId=1324077975251067189, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.济宁医学院公共卫生学院，山东 济宁 272067)]), AuthorCompany(id=1324077975330758968, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, xref=2., ext=[AuthorCompanyExt(id=1324077975339147577, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, companyId=1324077975330758968, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.内蒙古大学公共管理学院)])], figs=[ArticleFig(id=1324077977599877459, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Fig.1, caption=Inpatient health service utilization among rural middle-aged and elderly people, 2011-2020, figureFileSmall=E/R1l8ou/yAVN/HWnGEE4Q==, figureFileBig=R6lC0VAMN03LI/xcY4UrzA==, tableContent=null), ArticleFig(id=1324077977679569236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=图1, caption=2011—2020年农村中老年人住院服务利用情况, figureFileSmall=E/R1l8ou/yAVN/HWnGEE4Q==, figureFileBig=R6lC0VAMN03LI/xcY4UrzA==, tableContent=null), ArticleFig(id=1324077977872507221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Fig.2, caption=Concentration curve of inpatient health service utilization among rural middle-aged and elderly people, 2011-2020, figureFileSmall=ww796jYC+pySmPRkujOCKw==, figureFileBig=G7HRzL8h1kCwAIbSpIP/YQ==, tableContent=null), ArticleFig(id=1324077977956393302, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=图2, caption=2011—2020年农村中老年人住院服务利用集中曲线图, figureFileSmall=ww796jYC+pySmPRkujOCKw==, figureFileBig=G7HRzL8h1kCwAIbSpIP/YQ==, tableContent=null), ArticleFig(id=1324077978031890775, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Table 1, caption=

Basic socio-demographic characteristics[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计
（n=34 655）		住院
（n=4 869）		非住院
（n=29 786）		χ2P
基本特征
性别4.6780.031
男16 305(47.05)2 221(45.62)14 084(47.28)
女18 350(52.95)2 648(54.38)15 702(52.72)
年龄（岁）454.170<0.001
≤503 161(9.12)222(4.56)2 939(9.87)
51~6519 183(55.35)2 299(47.22)16 884(56.68)
≥6612 311(35.52)2 348(48.22)9 963(33.45)
婚姻状况97.835<0.001
其他4 885(14.10)909(18.67)3 976(13.35)
已婚29 770(85.90)3 960(81.33)25 810(86.65)
教育程度45.7256<0.001
小学及以下25 750(74.30)3 809(78.23)21 941(73.66)
初中及以上8 905(25.70)1 060(21.77)7 845(26.34)
是否参加医疗保险18.034<0.001
否1 615(4.66)169(3.47)1 446(4.85)
是33 040(95.34)4 700(96.53)28 340(95.15)
家庭人均消费性支出（元）282.602<0.001
低13 507(38.98)1 372(28.18)12 135(40.74)
中12 110(34.94)2 058(42.27)10 052(33.75)
高9 038(26.08)1 439(29.55)7 599(25.51)
生活方式
吸烟58.712<0.001
否21 126(60.96)3 210(65.93)17 916(60.15)
是13 529(39.04)1 659(34.07)11 870(39.85)
饮酒124.209<0.001
否23 202(66.95)3 599(73.92)19 603(65.81)
是11 453(33.05)1 270(26.08)10 183(34.19)
健康状况
自评健康498.630<0.001
否27 487(79.32)4 447(91.33)23 040(77.35)
是7 168(20.68)422(8.67)6 746(22.65)
多重慢性病501.554<0.001
否22 135(63.87)2 414(49.58)19 721(66.21)
是12 520(36.13)2 455(50.42)10 065(33.79)
抑郁症207.644<0.001
否22 712(65.54)2 748(56.44)19 964(67.02)
是11 943(34.46)2 121(43.56)9 822(32.98)
), ArticleFig(id=1324077978111582552, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=表1, caption=

基本社会人口学特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量合计
（n=34 655）		住院
（n=4 869）		非住院
（n=29 786）		χ2P
基本特征
性别4.6780.031
男16 305(47.05)2 221(45.62)14 084(47.28)
女18 350(52.95)2 648(54.38)15 702(52.72)
年龄（岁）454.170<0.001
≤503 161(9.12)222(4.56)2 939(9.87)
51~6519 183(55.35)2 299(47.22)16 884(56.68)
≥6612 311(35.52)2 348(48.22)9 963(33.45)
婚姻状况97.835<0.001
其他4 885(14.10)909(18.67)3 976(13.35)
已婚29 770(85.90)3 960(81.33)25 810(86.65)
教育程度45.7256<0.001
小学及以下25 750(74.30)3 809(78.23)21 941(73.66)
初中及以上8 905(25.70)1 060(21.77)7 845(26.34)
是否参加医疗保险18.034<0.001
否1 615(4.66)169(3.47)1 446(4.85)
是33 040(95.34)4 700(96.53)28 340(95.15)
家庭人均消费性支出（元）282.602<0.001
低13 507(38.98)1 372(28.18)12 135(40.74)
中12 110(34.94)2 058(42.27)10 052(33.75)
高9 038(26.08)1 439(29.55)7 599(25.51)
生活方式
吸烟58.712<0.001
否21 126(60.96)3 210(65.93)17 916(60.15)
是13 529(39.04)1 659(34.07)11 870(39.85)
饮酒124.209<0.001
否23 202(66.95)3 599(73.92)19 603(65.81)
是11 453(33.05)1 270(26.08)10 183(34.19)
健康状况
自评健康498.630<0.001
否27 487(79.32)4 447(91.33)23 040(77.35)
是7 168(20.68)422(8.67)6 746(22.65)
多重慢性病501.554<0.001
否22 135(63.87)2 414(49.58)19 721(66.21)
是12 520(36.13)2 455(50.42)10 065(33.79)
抑郁症207.644<0.001
否22 712(65.54)2 748(56.44)19 964(67.02)
是11 943(34.46)2 121(43.56)9 822(32.98)
), ArticleFig(id=1324077978195468633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Table 2, caption=

Multivariate logistic regression analysis of influencing factors inpatient service utilization of rural middle-aged and elderly people (n=34 655)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组OR值（95%CI）P值
基本特征
地区东部（参照组）1.00
中部1.32（1.22~1.44）<0.001
西部1.41（1.30~1.53）<0.001
东北1.04（0.89~1.23）0.054
性别女（参照组）1.00
男1.36（1.24~1.49）<0.001
年龄（岁）50（参照组）1.00
51~651.25（1.08~1.46）0.005
≥661.69（1.44~1.98）<0.001
婚姻状况其他（参照组）1.00
已婚0.85（0.78~0.93）<0.001
教育程度小学及以下（参照组）1.00
初中及以上0.95（1.25~1.60）0.200
参加医疗保险否（参照组）1.00
是1.49（1.26~1.76）<0.001
家庭人均消费性支出三等分
低（参照组）1.00
中1.49（1.37~1.62）<0.001
高1.39（1.28~1.52）<0.001
生活方式
吸烟否（参照组）1.00
是0.80（0.73~0.88）<0.001
饮酒否（参照组）1.00
是0.72（0.66~0.77）<0.001
健康状况
自评是否健康否（参照组）1.00
是0.41（0.37~0.46）<0.001
多重慢性病否（参照组）1.00
是1.66（1.56~1.77）<0.001
抑郁症否（参照组）1.00
是1.30（1.21~1.38）<0.001
), ArticleFig(id=1324077978275160410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=表2, caption=

农村中老年人住院服务利用率的影响因素的多因素logistic回归分析（n=34 655）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组OR值（95%CI）P值
基本特征
地区东部（参照组）1.00
中部1.32（1.22~1.44）<0.001
西部1.41（1.30~1.53）<0.001
东北1.04（0.89~1.23）0.054
性别女（参照组）1.00
男1.36（1.24~1.49）<0.001
年龄（岁）50（参照组）1.00
51~651.25（1.08~1.46）0.005
≥661.69（1.44~1.98）<0.001
婚姻状况其他（参照组）1.00
已婚0.85（0.78~0.93）<0.001
教育程度小学及以下（参照组）1.00
初中及以上0.95（1.25~1.60）0.200
参加医疗保险否（参照组）1.00
是1.49（1.26~1.76）<0.001
家庭人均消费性支出三等分
低（参照组）1.00
中1.49（1.37~1.62）<0.001
高1.39（1.28~1.52）<0.001
生活方式
吸烟否（参照组）1.00
是0.80（0.73~0.88）<0.001
饮酒否（参照组）1.00
是0.72（0.66~0.77）<0.001
健康状况
自评是否健康否（参照组）1.00
是0.41（0.37~0.46）<0.001
多重慢性病否（参照组）1.00
是1.66（1.56~1.77）<0.001
抑郁症否（参照组）1.00
是1.30（1.21~1.38）<0.001
), ArticleFig(id=1324077978359046491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Table 3, caption=

Concentrationindex and equity of inpatient health service utilization among rural middle-aged and elderly people, 2011-2020

, figureFileSmall=null, figureFileBig=null, tableContent=
时间集中指数95%置信区间
下限上限
20110.154 20.104 50.204 0
20130.013 4-0.024 40.051 3
20150.084 90.049 40.120 5
20180.043 60.013 30.073 8
20200.050 60.024 60.076 5
), ArticleFig(id=1324077978438738268, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=表3, caption=

2011年—2020年农村中老年人住院服务利用集中指数及公平性

, figureFileSmall=null, figureFileBig=null, tableContent=
时间集中指数95%置信区间
下限上限
20110.154 20.104 50.204 0
20130.013 4-0.024 40.051 3
20150.084 90.049 40.120 5
20180.043 60.013 30.073 8
20200.050 60.024 60.076 5
), ArticleFig(id=1324077978505847133, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=EN, label=Table 4, caption=

Decomposition of concentration index of inpatient health service utilization among rural middle-aged and elderly people, 2011-2020

, figureFileSmall=null, figureFileBig=null, tableContent=
变量20112013201520182020
集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）
地区（中部）-0.006 7-4.35-0.004 3-31.67-0.000 1-0.07-0.001 5-3.46-0.000 0-0.00
地区（西部）-0.003 3-2.16-0.007 6-56.79-0.000 7-0.90-0.004 6-10.61-0.007 1-13.85
地区（东北）0.000 20.130.000 10.51-0.002 4-2.770.000 40.95-0.000 0-0.07
男性0.000 70.48-0.000 3-2.04-0.001 1-1.33-0.001 2-2.710.001 42.70
51~65岁-0.002 3-1.47-0.003 3-24.61-0.003 2-3.75----
≥66岁-0.010 5-6.810.007 253.560.010 111.930.002 55.84-0.003 1-6.04
初中及以上教育程度0.000 10.06-0.000 0-0.270.000 70.880.000 00.06-0.000 5-0.91
婚姻状况（已婚）0.000 50.350.002 921.930.007 28.410.007 116.350.000 30.57
医疗保险（参加）0.000 10.07-0.002 2-16.69-0.004 0-4.73-0.001 1-2.44-0.000 1-0.23
人均消费性支出（中）0.082 853.67-0.009 2-68.62-0.023 4-27.51-0.013 3-30.43-0.032 8-64.95
人均消费性支出（高）0.019 512.640.024 9185.300.091 0107.170.034 980.100.084 0166.08
吸烟（是）-0.000 2-0.130.000 10.550.000 20.19-0.000 2-0.47-0.001 8-3.56
饮酒（是）-0.002 4-1.560.002 115.950.004 14.860.002 55.850.000 20.31
自评健康（是）-0.002 1-1.34-0.001 3-9.740.002 73.19-0.001 3-3.06-0.001 1-2.25
多重慢性病（是）0.009 15.87-0.001 1-8.41-0.002 9-3.470.000 51.090.001 93.68
抑郁症（是）-0.000 7-0.45-0.005 3-39.15-0.003 1-3.61-0.002 0-4.59-0.001 7-3.29
), ArticleFig(id=1324077978598121822, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077971723657504, language=CN, label=表4, caption=

2011年—2020年农村中老年人住院服务利用集中指数分解

, figureFileSmall=null, figureFileBig=null, tableContent=
变量20112013201520182020
集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）		集中指数的贡献贡献
（%）
地区（中部）-0.006 7-4.35-0.004 3-31.67-0.000 1-0.07-0.001 5-3.46-0.000 0-0.00
地区（西部）-0.003 3-2.16-0.007 6-56.79-0.000 7-0.90-0.004 6-10.61-0.007 1-13.85
地区（东北）0.000 20.130.000 10.51-0.002 4-2.770.000 40.95-0.000 0-0.07
男性0.000 70.48-0.000 3-2.04-0.001 1-1.33-0.001 2-2.710.001 42.70
51~65岁-0.002 3-1.47-0.003 3-24.61-0.003 2-3.75----
≥66岁-0.010 5-6.810.007 253.560.010 111.930.002 55.84-0.003 1-6.04
初中及以上教育程度0.000 10.06-0.000 0-0.270.000 70.880.000 00.06-0.000 5-0.91
婚姻状况（已婚）0.000 50.350.002 921.930.007 28.410.007 116.350.000 30.57
医疗保险（参加）0.000 10.07-0.002 2-16.69-0.004 0-4.73-0.001 1-2.44-0.000 1-0.23
人均消费性支出（中）0.082 853.67-0.009 2-68.62-0.023 4-27.51-0.013 3-30.43-0.032 8-64.95
人均消费性支出（高）0.019 512.640.024 9185.300.091 0107.170.034 980.100.084 0166.08
吸烟（是）-0.000 2-0.130.000 10.550.000 20.19-0.000 2-0.47-0.001 8-3.56
饮酒（是）-0.002 4-1.560.002 115.950.004 14.860.002 55.850.000 20.31
自评健康（是）-0.002 1-1.34-0.001 3-9.740.002 73.19-0.001 3-3.06-0.001 1-2.25
多重慢性病（是）0.009 15.87-0.001 1-8.41-0.002 9-3.470.000 51.090.001 93.68
抑郁症（是）-0.000 7-0.45-0.005 3-39.15-0.003 1-3.61-0.002 0-4.59-0.001 7-3.29
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2011—2020年我国农村中老年人住院服务利用情况及影响因素分析
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李东旭 1 , 苏敏 2 , 张苇乐 2
现代预防医学 | 卫生政策与管理 2026,53(4): 669-675
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现代预防医学 |卫生政策与管理 2026 , 53 (4) : 669 -675
2011—2020年我国农村中老年人住院服务利用情况及影响因素分析
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李东旭（1994—），男，博士，讲师，研究方向：卫生政策和卫生体系

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李东旭1, 苏敏2 , 张苇乐2
作者信息
  • 1.济宁医学院公共卫生学院，山东 济宁 272067
  • 2.内蒙古大学公共管理学院
通讯作者:
苏敏，E-mail:
作者简介:

李东旭（1994—），男，博士，讲师，研究方向：卫生政策和卫生体系

Analysis of inpatient health service utilization and its influencing factors among middle-aged and elderly people in rural China, 2011-2020
Dong-xu LI1, Min SU2 , Wei-le ZHANG2
Affiliations
  • School of Public Health, Jining Medical University, Jining, Shandong 272067, China
出版时间: 2026-02-25 doi: 10.20043/j.cnki.MPM.202411301
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摘要
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目的

了解我国农村地区中老年人住院服务利用率及公平性现状，探讨各影响因素对住院服务利用不公平的贡献程度。

方法

运用集中指数和集中曲线测量和展现农村地区中老年人住院服务利用的公平性，并利用集中指数分解法将其进行分解分析。

结果

2011年—2020年我国农村中老年人住院服务利用率分别为7.36%、11.41%、12.97%、16.90%和21.61%。2011年—2020年农村中老年人住院服务利用的集中指数分别为0.154 2、0.013 4、0.084 9、0.043 6和0.050 6。经济状况、地区和年龄是影响农村中老年人住院服务利用公平性的主要因素。

结论

住院服务利用主要集中在经济状况较好的人群中。缩小贫富差距与地区差距、关注老年群体及易受健康风险冲击的群体、完善医疗保险制度和提高农村医疗服务质量，对于降低住院服务利用不公平性具有重要意义。

农村  /  中老年人  /  住院服务利用  /  公平性  /  集中指数
Objective

To investigate the current status of inpatient health service utilization, rate and equity among middle-aged and elderly people in rural China, and to explore the contribution of each influencing factor to the inequity of inpatient health services utilization.

Methods

The concentration index and concentration curve were used to measure and show the equity of inpatient health service utilization among middle-aged and elderly people in rural areas, and used concentration index decomposition methods to conduct a decomposition analysis.

Results

From 2011 to 2020, the inpatient health service utilization rate for middle-aged and elderly people in rural China was 7.36%, 11.41%, 12.97%, 16.90%, and 21.61%, respectively. From 2011 to 2020, the concentration index of inpatient health service utilization rate among middle-aged and elderly people in rural China was 0.154 2, 0.013 4, 0.084 9, 0.043 6, and 0.050 6, respectively. Economic status, region, and age are the main factors affecting the equity of inpatient health services utilization among middle-aged and elderly people in rural areas.

Conclusion

The inpatient health service utilization is mainly concentrated among the economically well-off population. It is of great significance to reduce the inequity of inpatient health service by narrowing the gap between the rich and the poor and regional disparities, paying attention to the elderly and other groups that are vulnerable to health risks, improving the health insurance system and improving the quality of rural health service.

Rural areas  /  Middle-aged and elderly people  /  Inpatient health service utilization  /  Equity  /  Concentration index
李东旭, 苏敏, 张苇乐. 2011—2020年我国农村中老年人住院服务利用情况及影响因素分析. 现代预防医学, 2026 , 53 (4) : 669 -675 . DOI: 10.20043/j.cnki.MPM.202411301
Dong-xu LI, Min SU, Wei-le ZHANG. Analysis of inpatient health service utilization and its influencing factors among middle-aged and elderly people in rural China, 2011-2020[J]. Modern Preventive Medicine, 2026 , 53 (4) : 669 -675 . DOI: 10.20043/j.cnki.MPM.202411301
正文
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住院服务利用是医疗服务利用的重要组成部分之一，住院服务利用公平性是指患者不会因为可避免的且不公正的差异而减少或丧失住院服务利用的机会[1-2]。尤其是在我国农村地区，二元分割的城乡体制和不均衡的医疗资源配置，农村居民在住院服务利用的需求难以满足[3]，提高农村地区的住院服务利用的公平性是关键问题。
此前的研究对住院服务利用的影响因素展开探索，认为健康生活方式、体检和慢性病等是影响住院服务利用的重要因素[4-5]。还有研究发现住院服务利用可能因地区、医疗保险和经济等因素存在差异[6-7]。其中，经济条件是导致产生住院服务利用公平性差异的重要因素[8]，住院服务利用可能存在偏富人的不公平[9]。然而，已有研究对中老年人，尤其是对农村居民住院服务利用公平性的探索较少，并且缺少基于纵向数据的长期追踪和分析。因此，本研究使用2011—2020年中国健康与养老追踪调查数据（China health and retirement longitudinal survey，CHARLS），通过追踪10年间我国农村中老年人住院服务利用的现状、趋势、公平性及其贡献因素，为促进农村居民医疗服务利用和降低医疗服务利用不公平性提供政策建议。
1　资料与方法
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1.1　资料来源
本研究使用2011—2020年期间的五次CHARLS数据，CHARLS样本包含个体信息、医疗保险和医疗服务利用等数据，能够有效反映农村中老年人住院服务利用等健康不公平问题。本研究选择同时参与了2011、2013、2015、2018和2020年五次调查的个体，并筛选出农村地区且年龄在45岁及以上的中老年人为研究对象，经数据清洗（剔除关键变量的异常值，个别缺失值采用平均值补齐），最终获得由6 931个样本构成的五期平衡面板，共34 665条数据。CHARLS调查已经获得北京大学伦理审查委员会批准（IRB00001052-11015），研究对象均知情同意。
1.2　研究方法
1.2.1　集中曲线与集中指数
参照文献[10]，采用集中指数法测量不同社会经济状况下中老年人住院服务利用的公平性，计算公式如下：
其中，cov为协方差，Yi为住院服务利用的变量，μ是其均数；Ri为将个体按经济水平排序后第i个个体在总人数中的比例，Ri=i/N,i=1为最低收入个体，i=N为最高收入个体。集中指数为0，说明绝对公平，为1说明绝对不公平；集中指数为正值，表明经济状况较好的人群利用了更多的住院服务，反之为负值，表明经济状况较差的人群利用了更多的住院服务。
1.2.2　集中指数分解
参照文献[11]，采用集中指数分解发现各影响因素对不公平性的贡献。其模型如下：
式（2）中y是住院服务利用变量；αm是截距，和是边际效应，即dy/dxj和dy/dzk；ε是残差项。因变量y的集中指数分解结果如下所示：
其中，式中C是y的集中指数，μ是y的均数；Cj是χj的集中指数；Cμ是残差项的集中指数；和分别是χj和ε的均数。
1.3　指标定义
1.3.1　住院服务利用
本研究通过CHARLS调查中“过去一年，您住院过吗”这个问题来判断被调查者当年是否利用了住院服务（否=0，是=1）。
1.3.2　其他相关变量定义
农村中老年人所在家庭经济状况通过自报的家庭消费性支出减去家庭的医药卫生支出后3等分后由低到高分为低、中、高3个等级来衡量（在住院服务利用公平性分析和住院服务利用集中指数分解中，本研究均采用每年数据之间的横向比较，并未进行2011—2020期间各年份的纵向比较，因此，文中未考虑通胀因素影响。）。研究经验表明，消费性支出的偏倚较小，减去医药卫生支出更能真实的反映家庭的实际支配能力[12]。影响住院服务利用的变量包括：地区、婚姻状况、教育程度、是否参加医疗保险、经济状况、吸烟情况、饮酒情况、被调查者自评健康、是否患有多重慢性病及抑郁情况。
1.4　统计学方法
分类变量采用频数及百分比描述，组间差异采用χ2检验；采用基于固定效应的面板logistic模型进行影响因素分析；鉴于因变量为二分类变量，采用Probit模型对集中指数进行分解。所有数据均采用STATA 15.0软件进行统计分析，所有假设的检验水准α=0.05。
2　结果
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2.1　基本特征
2.1.1　社会人口学特征
研究对象中男性略少于女性，占比分别为47.05%和52.95%，以51-65岁居多（55.35%），85.90%的调查者婚姻状况为已婚，且大部分文化程度为小学及以下水平（占比74.30%）。约95.34%的调查者参加了医疗保险。有39.04%的调查者吸烟，饮酒的调查者占33.05%。认为自己身体处于健康状态的调查者占20.68%，36.13%的调查者患有多重慢性病，患有抑郁症的调查者占34.46%。详见表1。
2.1.2　农村中老年人住院服务利用的现状及变化趋势
2011年农村中老年人的住院服务利用率为7.36%，2013年住院服务利用率为11.41%，2015年住院服务利用率为12.97%，2018年住院服务利用率为16.90%，2020年住院服务利用率为21.61%，详见图1。
2.2　农村中老年人住院服务利用的影响因素分析
结果显示，中部地区（OR：1.32，95% CI：1.22～1.44）、西部地区（OR：1.41，95% CI：1.30～1.53）和东北地区（OR：1.32，95% CI：1.22～1.44）、51~65岁（OR：1.25，95% CI：1.08～1.46）和66岁（OR：1.69，95% CI：1.44～1.98）、参加医疗保险（OR：1.49，95% CI：1.26～1.76）、中等支出（OR：1.49，95% CI：1.37～1.62）和高支出（OR：1.39，95% CI：1.28～1.52）、患有多重慢性病（OR：1.66，95% CI：1.56～1.77）、抑郁症（OR：1.30，95% CI：1.21～1.38）是农村中老年人利用住院服务的危险因素。
已婚（OR：0.85，95% CI：0.78～0.93）、初中及以上受教育水平（OR：0.95，95% CI：1.25～1.60）、吸烟（OR：0.80，95% CI：0.73～0.88）、饮酒（OR：0.72，95% CI：0.66～0.77）、自评健康状况较好（OR：0.41，95% CI：0.37～0.46）是农村中老年人利用住院服务的保护因素。详见表2。
2.3　与经济水平相关的住院服务利用公平性分析
表3描述了集中指数结果。2011年、2013年、2015年、2018年和2020年农村中老年人住院服务利用率的集中指数分别为0.154 2、0.013 4、0.084 9、0.043 6和0.050 6，集中指数均为正值。图2展示了2011—2020年农村中老年人住院服务利用的集中曲线，整体上集中曲线位于公平线下方。综合来看，农村住院服务利用主要集中在经济状况较好的中老年人群中。
2.4　住院服务利用公平性的贡献程度分析
贡献率为正值时，该因素会增加偏富人的不公平性（经济状况较好的人利用更多的住院服务），反之，经济状况较差的人利用更多的住院服务。2011年，经济状况对不公平的贡献率最大（66.31%），其次为年龄（-8.28%），第三为多重慢性病（5.87%）。2013年，经济状况的贡献率最大（116.68%），其次为地区（-87.95%），第三为年龄（28.95%）。2015年，经济状况对不公平的贡献率最大（79.66%），其次为婚姻状况（8.41%），第三为年龄（8.18%）。2018年，经济状况对不公平的贡献率最大（49.67%），其次婚姻状况为（16.35%），第三为地区（-13.12%）。2020年，经济状况对不公平的贡献率最大（101.13%），其次为地区（13.92%），第三为年龄（-6.04%），详见表4。
3　讨论
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3.1　我国农村居民住院服务利用率呈上升趋势
根据2011—2020的五次调查数据显示，农村居民住院服务利用从7.36%增长至21.61%。住院服务率上升的原因可归结为以下几点：（1）居民的健康风险增加。当前我国老龄化不断加剧，慢性病风险增加，农村居民慢性病患病率增幅高于城市居民[13]。（2）农村医疗服务体系逐渐完善。以乡镇卫生院为核心的基层医疗服务体系不断完善，住院服务可及性不断加强。（3）医疗保险得到进一步发展。医疗保险降低了医疗服务的实际自付费用，有助于提高住院服务利用率[14]。此外，部分地区医疗保险报销仅限于住院服务利用和纳入范围的门诊慢性病[15]，这可能会促进农村居民利用住院服务。然而，住院率提高并未缓解住院服务利用的不公平。这可能是因为高住院率并不一定代表更好的利用了住院服务[8]。尽管农村中老年人有更多机会利用住院服务，但是由于住院的经济压力较大，因此经济状况更好的群体更有能力承担住院花费并利用住院服务。
3.2　地区、年龄、婚姻、医疗保险、经济状况和健康状况是影响住院服务利用的主要因素
根据结果显示，老年人抵御健康风险的能力更低，因此老年人对对住院服务的需求高于年轻人。研究结果显示，医疗保险提高了医疗服务利用率。医疗保险可以减轻患者的医疗负担[16]，因此有医疗保险的群体更倾向利用住院服务。我们的研究还发现，医保参保率已达95.54%，但高收入组住院率仍显著更高，这可能是因为，尽管医疗保险参保率更高，但是农村低收入群体对部分自付费用和垫付住院费用的支付能力仍有限，自付医疗支出占可支配收入比重过高[17-18]，并且健康素养有待进一步提高，这导致住院率低于高收入群体。相较于经济状况较差的人群，经济状况较好的群体能够承担更多的医疗费用，因此更倾向于利用住院服务。由于多重慢性病的治疗周期更长，面临的健康风险更大，因此患有多重慢性病的群体更倾向利用住院服务[19]。此外，抑郁群体更倾向于利用住院服务，这是因为抑郁可能带来生理和心理等方面的健康危害，因此增加了住院服务利用。
3.3　农村地区住院服务利用呈现偏富人的不公平
研究结果显示，我国农村地区住院服务利用存在偏富裕群体的不公平。在卫生服务需求相同的情况下，经济状况较好的居民获得了更多的服务，而经济状况较差的居民由于经济问题得不到所需的服务。特别是对于农村地区的中老年人来说，医疗服务可及性较低，就医交通成本更高，并且由于收入低，价格弹性敏感[20]。此外，地区和年龄是住院服务利用不公平的重要贡献因素。地区医疗资源的不平等和贫富差距加重了住院服务的不公平性，并且由于年龄和健康成反比，因此年龄越大，疾病风险越高。
总体而言，我国农村居民住院服务利用率呈上升趋势，但存在偏向富人的不公平。因此，应缩小贫富差距与地区差距，关注具有健康风险和经济风险的群体，促进基本医疗服务均等化。应普及并完善医疗保险制度，降低医疗保险缴费标准，扩大报销范围，缓解由收入差距带来的不公平问题。最后，应提高基层医疗服务质量，增强农村住院服务可及性，减少农村居民住院服务利用的不公平。
基金
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  • 国家自然科学基金项目(72164031)
  • 国家自然科学基金项目(72204128)
文献
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doi: 10.20043/j.cnki.MPM.202411301
  • 接收时间：2024-11-15
  • 首发时间：2026-11-02
  • 出版时间：2026-02-25
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  • 收稿日期：2024-11-15
基金
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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    1.济宁医学院公共卫生学院，山东 济宁 272067
    2.内蒙古大学公共管理学院

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苏敏，E-mail:
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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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