Zhongguo quanke yixue (Jun 2024)
A Decomposition Study of Health Status Disparities among Older Adults with Multimorbidity: a Multiple Level Model Based on Health Double Factors
Abstract
Background Currently, research on the factors influencing the health status of older adults with multimorbidity in China is scattered, and it is difficult to give a comprehensive consideration from a holistic perspective, and the contribution of factors leading to health disparities is not explored, resulting in the ineffectiveness of current health management often programs in older adults with multimorbidity. Objective By introducing a health bifactor model, this study aims to understand the endogenous and exogenous influencing factors and their contributions to the health of older adults with multimorbidity and provide a practical basis for developing precise health management plans for older adults with multimorbidity. Methods In this study, using the China Health and Retirement Longitudinal Survey (CHARLS) 2018 data and introducing the two-factor model of health developed from the Grossman health production function (including both endogenous and exogenous aspects of health determinants). First, the Wilcoxon rank sum test was used to analyze whether there were differences in the health status of older adults with multimorbidity by gender. Secondly, the OLS regression model was used to analyze the mechanism of the two-factor model of health on the health of older adults with multimorbidity. Finally, the Shapley value method was further used to decompose the contribution of health endogenous factors to their health. Results The study found that factors such as still drinking alcohol, having no disease control methods, being satisfied with medical services, having a high level of education, having a pension, not using health services, attending free health checks, caring for grandchildren and being satisfied with their children's relationship were more likely to improve the health of older people with multiple chronic conditions. The results of the Shapley decomposition showed that socioeconomic status was the most important factor in the full sample, while family health support, health-related behaviors, and health-related behaviors were the most important factors. Coping strategies was the next most important, and social health resources was the least influential. In the gender subgroup analysis, socioeconomic status remained the most important factor; for older men with multiple chronic illnesses, health-related behaviors were the next most important factor; for older women with multiple chronic illnesses, coping strategies were the next most important. Conclusion The health status of older men with multimorbidity is better than that of women, socioeconomic status is the most important factor affecting the health of older adults with multimorbidity, and the remaining four dimensions have different contributions to the health differences between men and women. It is recommended that precise health management should be implemented according to the size of the contribution of each dimension of different health endogenous factors to improve the health status of older adults with multimorbidity with maximum benefit.
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