Abstract
刘红芸,冯传腾,余彬,马花,白懿弘,贾鹏,窦青瑜,杨淑娟.基于双重差分法分析长期照护保险对失能老年人跌倒发生率的影响[J].Chinese journal of Epidemiology,2024,45(5):673-678
基于双重差分法分析长期照护保险对失能老年人跌倒发生率的影响
Effect of long-term care insurance on incidence of falls in old people with disability based on difference-in-differences method
Received:September 13, 2023  
DOI:10.3760/cma.j.cn112338-20230913-00153
KeyWord: 长期照护保险  失能老年人  双重差分法  跌倒
English Key Word: Long-term care insurance  Old people with disability  Difference-in-differences method  Fall
FundProject:国家重点研发计划(2023YFC3604701,2020YFC2008005,2020YFC2008000);四川大学-达州校市战略合作专项(2020CDDZ-26-SCU);国家自然科学基金(42271433)
Author NameAffiliationE-mail
Liu Hongyun West China School of Public Health/The Fourth Hospital of West China, Sichuan University, Chengdu 610041, China  
Feng Chuanteng West China School of Public Health/The Fourth Hospital of West China, Sichuan University, Chengdu 610041, China
Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610207, China 
 
Yu Bin West China School of Public Health/The Fourth Hospital of West China, Sichuan University, Chengdu 610041, China
Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610207, China 
 
Ma Hua West China School of Public Health/The Fourth Hospital of West China, Sichuan University, Chengdu 610041, China  
Bai Yihong Department of Epidemiology & Biostatistics, Western University Ontario, Ontario N6G 2M1, Canada  
Jia Peng School of Resources and Environmental Sciences, Wuhan University, Wuhan 430072, China
Hubei Luojia Laboratory, Wuhan 430072, China
School of Public Health, Wuhan University, Wuhan 430071, China
International Institute of Spatial Lifecourse Health, Wuhan University, Wuhan 430072, China 
 
Dou Qingyu National Clinical Medical Research Center for Geriatric Diseases/West China Hospital of Sichuan University, Chengdu 610041, China ddqqking@126.com 
Yang Shujuan West China School of Public Health/The Fourth Hospital of West China, Sichuan University, Chengdu 610041, China
International Institute of Spatial Lifecourse Health, Wuhan University, Wuhan 430072, China 
rekiny@126.com 
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Abstract:
      目的 分析长期照护保险对失能老年人跌倒发生率的影响,以及不同居住方式的效应修饰作用。方法 基于2014年7月至2021年6月成都市申请长期照护保险的城镇居民住院记录中的出院诊断记录,以得到长期照护险覆盖者为干预组,未覆盖者为对照组,使用双重差分法分析长期照护保险实施前后跌倒发生率的变化,并采用分层分析探索不同居住方式的效应修饰作用。结果 长期照护保险的覆盖显著降低了老年人每月跌倒发生率[干预者平均处理效应(ATT)=-1.21%(95%CI:-1.82%~-0.60%)],且效果随时间的增加而增加[ATT=-1.26%(95%CI:-1.93%~-0.59%)]。长期照护保险对与配偶/亲属居住[ATT=-0.92%(95%CI:-1.47%~-0.37%)]以及居住在养老机构/医院[ATT=-2.10%(95%CI:-3.81%~-0.40%)]的老年人有显著影响,在独居人群中效应不显著。结论 长期照护保险能有效降低老年人的跌倒发生率,对失能老年人有积极影响,与家人居住或在养老机构/医院居住对长期照护保险政策实施效果有效应修饰作用,后期应关注重点人群,扩大长期照护保险的覆盖范围。
English Abstract:
      Objective To analyze the effect of long-term care insurance on the incidence of falls in old people with disability, and the modification effect of different living arrangements. Methods Based on the discharge diagnosis records of the hospitalization in urban residents who applied for long-term care insurance in Chengdu from July 2014 to June 2021, those who received long-term care insurance were selected as the intervention group and those who received no long-term care insurance were selected as the control group, the changes in the incidence of falls before and after the long-term care were analyzed using difference-in-differences method, and the modification effects of different living arrangements were explored using stratified analysis.Results Long-term care insurance significantly reduced the risk for monthly incidence of falls in older adults [average treatment effects on treated (ATT) = -1.21% (95%CI: -1.82%--0.60%)], and the effect increased over time (ATT=-1.26%, 95%CI: -1.93%--0.59%). Long-term care insurance had a significant effect on reducing the incidence of falls in old people living with spouses/family members (ATT=-0.92%, 95%CI: -1.47%--0.37%) and in nursing facilities/hospitals (ATT=-2.10%, 95%CI: -3.81%--0.40%), but it had no significant effect in those living alone.Conclusions Long-term care insurance can effectively reduce the incidence of falls in old people with disability, showing a positive effect. Living with family members or in nursing facilities/hospitals has a modification effect of the implementation of long-term care insurance policy. It is necessary to pay attention to key populations in the future and expand the coverage of long-term care insurance.
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