Abstract: Background With the continuous advancement of the aging process in our country，the health problems of the middle-aged and elderly population has increasingly become a social problem which cannot be overlooked. Objective To comprehensively understand the prevalence trend of health shock in rural middle-aged and elderly people in Ningxia during the 14 years before and after poverty alleviation， identify the dynamic changes of related influencing factors， and provide data support for effective identification and intervention of health shock. Methods This study selected the health follow-up data of four periods：the early stage of the new medical reform（2009），the promotion period of health poverty alleviation（2015），the poverty alleviation period（2019），and the transition period of rural revitalization and health poverty alleviation（2022）. The research subjects were obtained by adopting the method of multi-stage stratified cluster random sampling. Firstly，all the towns and townships in the sample counties（Yanchi，Haiyuan，Pengyang，Xiji）were counted. The administrative villages of each town and township were divided into three levels according to the high，medium and low economic levels. 40% of the natural villages were randomly selected from each level，and 33 rural households were selected from each village by the method of systematic sampling. The middle-aged and elderly people aged 45 and above in the household were taken as the research subjects and a questionnaire survey was conducted. The contents of the questionnaire survey include general demographic characteristics，indicators related to family economic status，health-related indicators，indicators related to the utilization of health services，and indicators related to health poverty alleviation policies. After excluding subjects with missing values for important variables，6，351，8，035，8，566，and 9，337 research subjects were included in the four phases of the survey，respectively. The prevalence trend changes in the incidence of health shocks were analyzed using the χ2 test. The single factors influencing the occurrence of health shocks were explored using the χ2 test or t-test. The fixed binary Logit regression model was used based on Grossman's theory of health needs to identify the effect magnitudes of the related influencing factors. Results In 2009，2015，2019 and 2022，the incidence of health shock in the rural elderly in Ningxia was 29.74%（1 889/6 351），27.18%（2184/8 035），31.27%（2 679/8 566）and 25.00%（2 334/9 337）. The difference was statistically significant（χ2 =22.520，P<0.001）， respectively. The regression results showed that before poverty alleviation，higher per capita annual income and larger family size were the main positive influencing factors of health shocks（P<0.001），while poor self-rated health status，debt due to illness and older age were the main negative influencing factors（P<0.001）. After poverty alleviation，higher per capita annual income，larger family size and medical consultations within two weeks were the main positive influencing factors（P<0.001），while poor self-rated health status，debt due to illness and annual hospitalization were the main negative influencing factors（P<0.001）. The impact of smoking on health was not significant（P>0.05）.Conclusion In the 14 years before and after poverty alleviation，the incidence of health shock of the middle-aged and elderly people in rural Ningxia has decreased significantly. The main factors affecting the occurrence of health shock are higher per capita annual income，larger family size，medical consultations within two weeks and debt due to illness. It is necessary to increase the policy support of government funds，improve the level of residents' income，and improve the medical security system to reduce the incidence of health shocks among the middle-aged and elderly people in rural Ningxia.

Key words: Health status, Health shocks, Grossman's theory of health needs, Dynamic monitoring, Influencing factor, Middle-aged and elderly people

摘要： 背景 随着我国老龄化进程的不断推进，中老年人口的健康冲击问题日益成为不可小觑的社会问题。目的 全面了解宁夏农村中老年人在全面脱贫前后的健康冲击情况，识别相关影响因素，为健康冲击的有效识别和干预提供数据支持。方法 本研究选用新医改前期（2009年）、健康扶贫推进期（2015年）、脱贫攻坚期（2019年）、乡村振兴与健康扶贫衔接期（2022年）4期健康随访数据。采取多阶段分层整群随机抽样的方法获取研究对象，首先统计样本县（盐池、海原、彭阳、西吉）中的所有乡镇，将各乡镇的行政村按经济水平高、中、低分为三个层级，每层随机抽取40%的自然村，每村按照系统抽样的方法抽取33户农村家庭户，将家庭户中年龄在45周岁及以上的中老年人群作为研究对象，进行问卷调查。问卷调查内容包括一般人口学特征、家庭经济状况相关指标、健康相关指标、卫生服务利用相关指标以及健康扶贫政策相关指标，剔除重要变量缺失后，四期调查分别纳入6351、8035、8566、9337名研究对象。利用χ2检验分析健康冲击发生率的流行趋势变化，运用χ2检验或t检验探讨影响健康冲击发生的单因素，基于Grossman健康需求理论采用固定二元Logit回归模型识别相关影响因素的效应大小。结果 2009、2015、2019、2022年宁夏农村中老年人健康冲击发生率分别为29.74%（1889/6351）、27.18%（2184/8035）、31.27%（2679/8566）、25.00%（2334/9337），4次调查的健康冲击发生率呈下降趋势，差异有统计学意义（χ2趋势=22.520，P <0.001）。回归结果显示，脱贫前，人均年收入水平较高及家庭规模较大是健康冲击的主要正向影响因素（P <0.001），自评健康状况差、因病借贷及年龄较大是健康冲击的主要负向影响因素（P <0.001）。脱贫后，人均年收入水平较高、家庭规模较大及两周就诊是健康冲击的主要正向影响因素（P <0.001），自评健康状况差、因病借贷和年需住院是健康冲击的主要负向影响因素（P <0.001）。吸烟对健康冲击的发生影响不显著（P >0.05）。结论 在全面脱贫前后14年间，宁夏农村中老年人健康冲击发生率显著降低，人均年收入水平较高、家庭规模较大、两周就诊及因病借贷是影响健康冲击发生的主要因素。应加大政府资金政策支持，提高居民收入水平，同时完善医疗保障体系，降低宁夏农村中老年人群健康冲击发生率。

关键词: 健康状况, 健康冲击, Grossman 健康需求理论, 动态监测, 影响因素, 中老年人