| Objective This article focuses on the elderly population in China,analyzing the current situation and influencing factors of their chronic comorbidities,health-related quality of life(HRQo L),and utilization of medical services.Understanding the correlation rules and spatial distribution of chronic comorbidities among the elderly population.Analyzing the impact of chronic comorbidities on HRQo L and utilization of medical services,exploring the interactive effects of chronic comorbidities and HRQo L on the utilization of medical services,aiming to provide new perspectives and ideas for improving the precision management of elderly people with chronic comorbidities,enhancing the HRQo L of the elderly population,and optimizing the allocation of resources for chronic disease prevention and health care.Methods This study was a retrospective study,with data from the 2018 China Health and Retirement Longitudinal Study(CHARLS).The study population consisted of 9,854 elderly people aged 60 and above,including 6,338 elderly people with chronic comorbidities and 3,516 elderly people without chronic comorbidities.Data analysis was performed using Stata 15.0 and R 4.2.2 software,while the spatial distribution of chronic comorbidities and the web association map of chronic diseases were drawn using Arc GIS 10.2 and IBM SPSS Modeler 18.0.Firstly,statistical descriptions were conducted using rates/composition ratios,mean ± standard deviation((?)±s),and median(quartiles)[M(Q1,Q3)].Secondly,the association rule of Apriori and Web graph were used to explore the correlation between chronic diseases,and the chronic disease comorbidity pattern was analyzed.The influencing factors of chronic disease comorbidity were analyzed by Logistic regression model.Health-related quality of life was measured by the five-dimension European Health Scale(EQ-5D-3L scale),and the influencing factors of health-related quality of life were analyzed by Tobit regression model.Then Chi-square test and Logistic regression model were used to analyze the influencing factors of medical service utilization.Finally,multiplicative interaction analysis was used to investigate the interaction effect of chronic comorbidities and HRQo L on the utilization of medical services.Results(1)Results of the study on the current status and influencing factors of chronic comorbidities among elderly people showed that among 9,854 elderly people,there were 6,338 with chronic comorbidities,resulting in a prevalence rate of 64.32%.The average number of chronic diseases was 2.51 ± 1.96,with an average age of 68.71± 6.56 years old.The prevalence of chronic comorbidities among elderly people varied from 48.95%(234/478 in Guangdong Province)to 83.67%(41/49 in Xinjiang Uygur Autonomous Region).Female(OR=1.473,95%CI: 1.302-1.666),older age(65-69years: OR=1.272,95%CI:1.143-1.416.70-74 years: OR=1.389,95%CI: 1.224-1.576.75-79 years: OR=1.422,95%CI: 1.221-1.655),minority ethnicity(OR=1.192,95%CI:1.005-1.412),and former smoking(OR=1.900,95%CI: 1.663-2.170)were the risk factors of chronic comorbidities among elderly people.Living in rural areas(OR=0.822,95%CI: 0.722-0.917),participating in urban and rural residents’ insurance(OR=0.703,95%CI: 0.609-0.810),having no insurance(OR=0.514,95%CI: 0.389-0.678),having no physical disability(OR=0.514,95%CI: 0.470-0.562),and having normal sleep duration(OR=0.668,95%CI: 0.607-0.734)or long sleep duration(OR=0.562,95%CI:0.484-0.652)were the protective factors of chronic comorbidities among elderly people.(2)Results of the study on the comorbidity patterns of chronic diseases among elderly people showed that among the 14 chronic diseases,the top three diseases with the highest prevalence rates were hypertension with 4,495 cases(45.62%),arthritis or rheumatism with 4,413 cases(44.78%),and stomach or digestive diseases with 3142cases(31.89%).The top three combinations of binary chronic comorbidities were hypertension and arthritis or rheumatism with 2,151 cases(33.90%),arthritis or rheumatism and stomach or digestive diseases with 1,892 cases(29.90%),and dyslipidemia and hypertension with 1,646 cases(26.00%).The top three combinations of tripartite chronic comorbidities were hypertension,stomach or digestive diseases,and arthritis or rheumatism with 911 cases(14.40%),hypertension,arthritis or rheumatism,and heart disease with 841 cases(13.30%),and dyslipidemia,arthritis or rheumatism,and hypertension with 835 cases(13.20%).Among the 16 association rules of chronic comorbidities,eight were related to chronic pulmonary diseases and asthma,five were related to kidney diseases,and four were related to memory-related diseases.The top three binary association rules in terms of confidence were {asthma}→{chronic pulmonary diseases},{memory-related diseases}→{heart disease},and {diabetes or high blood sugar}→{dyslipidemia}.The top three tripartite association rules in terms of confidence were {stomach or digestive diseases,asthma}→{chronic pulmonary diseases},{kidney diseases,asthma}→{chronic pulmonary diseases},and {arthritis or rheumatism,asthma}→{chronic pulmonary diseases}.(3)Results of the study on HRQo L among elderly people showed that the average health utility value of 9,854 elderly people was 0.864 ± 0.106,and the two dimensions with the highest proportion of difficulties were mobility with 77.04% and pain/discomfort with 62.21%.Tobit regression analysis showed that being female(β=-0.030,P<0.001),increasing age(β=-0.001,P<0.001),living in rural areas(β=-0.007,P=0.010),being widowed(β=-0.014,P<0.001)or unmarried(β=-0.043,P<0.001),having more chronic diseases(1 disease: β=-0.027,2 diseases: β=-0.050,3 diseases:β=-0.067,4 diseases: β=-0.081,≥5 diseases: β=-0.108,P<0.001),not engaging in exercise(β=-0.049,P<0.001),and not engaging in social activities(β=-0.015,P<0.001)were risk factors of HRQo L among elderly people.Education level(primary school/private tutoring: β=0.012,junior high school: β=0.027,high school/ vocational college:β=0.030,college degree or above: β=0.038,P<0.001),absence of physical disability(β=0.036,P<0.001),higher personal income(1,621-18,438 yuan: β=0.020,≥18,439yuan: β=0.039,P<0.001),no history of traffic accidents(β=0.040,P<0.001),and normal(β=0.034,P<0.001)or long sleep duration(β=0.029,P<0.001)were protective factors of HRQo L among elderly people.(4)Results of the study on the utilization of medical services among elderly people showed that among 9,854 elderly people,1,594 people had visited outpatient clinics within the past four weeks,with a four-week outpatient visit rate of 16.18%,and 1,953 people had been hospitalized within one year,with a one-year hospitalization rate of19.82%.The number of chronic diseases,medical insurance,social activities,and life satisfaction were factors affecting outpatient visits within the past four weeks(P<0.05).The outpatient visit risks of elderly people with 1,2,3,4,and ≥5 chronic diseases were 1.721 times(95%CI: 1.329-2.228),2.668 times(95%CI: 2.081-3.421),3.367times(95%CI: 2.619-4.330),3.550 times(95%CI: 2.726-4.622),and 5.704 times(95%CI: 4.460-7.296),respectively,compared with elderly people without chronic diseases.Gender,number of chronic diseases,activities of daily living,depression,medical insurance,and social activities were factors affecting hospitalization within one year(P<0.05).The risks of hospitalization within one year for elderly people with 1,2,3,4,and ≥5 chronic diseases were 1.955 times(95%CI: 1.507-2.536),2.931 times(95%CI: 2.279-3.771),4.173 times(95%CI: 3.240-5.375),5.373 times(95%CI: 4.136-6.978),and 7.232 times(95%CI: 5.620-9.306),respectively,compared with elderly people without chronic diseases.Among the 1,594 elderly people who visited outpatient clinics within the past four weeks,the average number of outpatient visits was 2.31 ±2.87,and among the 1,953 elderly people with hospitalization experience within one year,the average number of hospitalizations was 1.63 ± 1.39.(5)Results of the interaction study showed that there was no multiplicative interaction between comorbidity and HRQo L on outpatient visits and hospitalization(P>0.05),but there was an additive interaction for both.After adjusting for confounding factors,there was an additive interaction between comorbidity and HRQo L on outpatient visits,with a RERI of 1.164 and an AP value of 0.275,and an SI value of1.563.The effect of comorbidity and impaired HRQo L on outpatient visits was 1.563times(95%CI: 1.037-2.356)the sum of the effects of the two factors alone.Cases attributable to the additive interaction of comorbidity and impaired HRQo L accounted for 27.5% of all outpatient visits.There was an additive interaction between comorbidity and HRQo L on hospitalization,with a RERI of 1.891 and an AP value of0.365,and an SI value of 1.827.The effect of comorbidity and impaired HRQo L on hospitalization was 1.827 times(95%CI: 1.235-2.702)the sum of the effects of the two factors alone.Cases attributable to the additive interaction of comorbidity and impaired HRQo L accounted for 36.5% of all hospitalizations.Conclusions(1)The prevalence of comorbid chronic diseases among elderly people in China is high,with a trend of higher prevalence rates in the northern and western regions.The clustering of comorbid chronic diseases is mainly concentrated in the northwest region of China.Sex,age,location,ethnicity,type of medical insurance,sleep time,and smoking are the factors influencing the comorbidity of chronic diseases in elderly people.Older women,those aged 65-79 years,those living in urban areas,those of ethnic minority background,those who do not participate in regular exercise,and those who have quit smoking are at higher risk of comorbid chronic diseases.(2)Among the 14 chronic diseases studied,the three most prevalent were hypertension,arthritis or rheumatism,and gastrointestinal diseases.Hypertension and arthritis or rheumatism were the two most common diseases in binary and ternary comorbid chronic disease combinations.The association rules with chronic lung diseases and asthma were the most frequent in highly correlated comorbid patterns.Having asthma with comorbidities increased the risk of chronic lung diseases.Elderly people with arthritis were at a higher risk of lung diseases than those without arthritis.Abnormal blood lipids were strongly correlated with diabetes or high blood sugar,hypertension,and heart disease.(3)The main dimensions affecting HRQo L among elderly people in China were functional ability and pain/discomfort.Sex,age,location,level of education,marital status,presence of disability,personal income,traffic accidents,sleep time,number of chronic diseases,exercise,and social activities were the factors affecting HRQo L.Elderly people with higher levels of education,personal income,and no disability or traffic accidents,and regular sleep patterns had higher HRQo L scores.Women,those living in rural areas,those who are divorced/separated,widowed,or unmarried,those who do not exercise,do not participate in social activities,those who are older or have multiple chronic diseases,had lower HRQo L scores.Elderly people with comorbid chronic diseases had even lower HRQo L than those without comorbidities.With an increase in the number of comorbid chronic diseases,HRQo L decreases further.(4)The number of chronic diseases,medical insurance,social activities,and life satisfaction are factors influencing an elderly person’s outpatient visits in the past four weeks.For annual hospitalizations,sex,the number of chronic diseases,activities of daily living,depression,medical insurance,and social activities are the influential factors.The higher the number of chronic diseases,the higher the outpatient and hospitalization rates.Elderly people with comorbid chronic diseases have higher healthcare utilization rates than those without comorbidities.Elderly people with a higher number of chronic diseases have a relatively higher number of hospitalizations.(5)There was a positive additive interaction between comorbid chronic diseases and HRQo L on outpatient visits and hospitalization in elderly people in China,but no multiplicative interaction was found.Comorbidities and impaired health function had a synergistic effect,leading to an increase in the number of healthcare service utilization among elderly people. |
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