关键词: 自评健康, 卫生服务利用, 老年人

Abstract: Background　The aging rate of Chinese population has greatly exceeded the average global level. More than 180 million Chinese elderlies are suffering from one or more chronic diseases，accounting for 75% of the total elderlies，subjecting them to be the key population for health services utilization. Objective　To explore the relationship between self-rated health status and utilization of health services of the elderlies，providing a reference for the construction of a healthcare system ensuring the health of elderly people. Methods　China Health and Retirement Longitudinal Study（CHARLS） is a large-scale interdisciplinary follow-up survey project conducted by Peking University. The survey sampled around 18 000 middle-aged and old Chinese people residents（≥45 years old） from 450 villages of 150 districts/counties in 28 provinces（municipalities） across China，serving as a set of survey database representing this group of Chinese people. The CHARLS questionnaire includes the basic demographic information，family structure and financial support，health status，physical measurement，health service utilization and medical insurance，work，retirement and pension，income，consumption，assets as well as essential community conditions. In this study，we selected part of the surveyees（≥60 years old） of the 2015 CHARLS as the participants，and studied their demographic information（gender，age，marital status，education level and residence），income（including asset income） and consumption，anthropometric parameters（height and weight），health status（general health status and medical history），lifestyle habit（physical exercise，social activities，smoking and drinking），and utilization of health services（outpatient and inpatient services）. We used the framework of Anderson's behavioral model to explore the impact of self-rated health status on health services utilization. We performed statistical analysis using chi-square test and multivariate Logistic regression in SPSS 20.0. Results　 Of the 4 089 responders for self-rated health status in the survey，3 266（79.87%） rated their health as poor，and 265（8.11%） of them should have used inpatient services in the past year. Among the 8 340 responders for use of outpatient services in the past 4 weeks，1 681（20.16%） used such services. Of the 8 344 responders for use of inpatient services in the past year，1 382（16.56%） used such services. Logistic regression analysis showed that the utilization rates of outpatient services in smokers who had quit smoking and those who had poor self-rated health status were 1.505 and 2.636 times higher than those who were still smoking and those with good self-rated health status（P<0.05）；the utilization rates of inpatient services in elderly people aged over 80 was 1.666 times of those aged 60-69 years，and those who did not drink alcohol were 1.613 times as much as those who drank more than once a month，the utilization rates of inpatient services in smokers who had quit smoking and never smokers were 2.204 and 1.698 times higher than those who were still smoking，the utilization rates of inpatient services in patients with poor self-rated health status were 2.630 times higher than those in those with good self-rated health status（P<0.05）. Conclusion　The overall self-rated health status of the elderly was relatively poor，which may significantly affect their utilization of health services. To improve the health management of the elderly，the monitoring and research of self-rated health status should be further strengthened for delivering health services，and the construction of primary healthcare system should be strengthened.

Key words: Self-rated health, Medical care utilization, Aged