Heterogeneous Health Groups And Healthcare Utilization Among Older Adults In China

ObjectivesOur study aimed to assess the heterogeneous health groups among older adults in China,to discuss factors affecting these health groups on the whole sample and stratifications of gender and region,furthermore,to evaluate how these groups may impact older adults’ healthcare utilization.MethodsData came from the Chinese Longitudinal Healthy Longevity Survey in 2014.The study population were older adults aged 65 and over.Seven health indicators were selected from the physical,psychological,and social dimensions of health,including ADLs,IADLs,cognitive impairment,depression,structural and functional social relationships.Relevant social-demographic and socioeconomic factors were classified to predisposing and enabling factors based on the Andersen’s behavioral model.Latent class analysis was used to identify heterogeneous health groups.Multinomial logistic regression models were adopted to examine the influencing factors on health groups.By using the two-part model,healthcare utilization among older adults was also discussed.ResultsOur study identified four heterogeneous health groups and labelled by characteristics of each groups’ health indicators:Lacking socialization(10.5%),High comorbidity(17.6%),Severe disability(8.1%)and Relative health(63.8%).Our study found that social-demographic and socioeconomic factors had a significant effect on health groups.Those older or living with others were less likely to be in the Relative Health group.The higher income could benefit health especially for those in the Lacking Socialization group.Older adults in marriage or with higher education were less likely to be in the Lacking Socialization group and those living in the eastern region tended to lack socialization.Those females,living in the eastern or middle region were more likely to suffer from multiple comorbidities while those in the eastern region,enrolled in Urban Employee Basic Medical Insurance were less likely to have severe disabilities.Furthermore,our study discussed the significant effects of those factors by the stratifications of gender and region.Under the stratification of gender,marriage had more effect on males while education and main occupation before age 60 had more effects on females.Under the stratification of region,olderest old and New Rural Cooperative Medical Scheme had more significant effects on western region while living with others had more significant effect on eastern region.With the Relative Health group as the reference,our study found that older adults in the High Comorbidity group were more likely to visit outpatient services and incurred the highest outpatient expenditures.Those in the Lacking Socialization group cost higher inpatient expenditures.Those in the Severe Disability group caused a tremendous burden on outpatient and inpatient services.By introducing the heterogeneous health groups,the effect of social-demographic and socioeconomic factors on healthcare utilization had changed.Age and main occupation before age 60 among predisposing factors and resident areas among enabling factors had significant effects on outpatient services,while these factors were not significant on inpatient services.ConclusionsOur study has chosen health indicators from multidimensions and identified heterogeneous health groups among the older population.It helped to understand the complexity of health conditions among older adults more comprehensively.Hence,multi-dimensions should be considered thoughtfully when evaluating the health of older adults.Our study found that the effects of social-demographic and socioeconomic factors have a significant difference in the stratifications of gender and region,which suggested the existing inequality on age and region.The equity on older adults’ health should be guaranteed during the health policy setting.In the meantime,our study found that older adults from heterogeneous health groups have different patterns of healthcare utilization.Hence,the diversity among health groups should be considered and healthcare services should be provided with a target to improve the efficiency of healthcare services.