As global aging advances, the number of people with disability is increasing. Disability seriously affects quality of life and increases the burden caused by healthcare expenditure. Most domestic studies focus on disabilities in middle-aged and elderly people, but there is a lack of longitudinal studies on the fairness of health service utilization and changes in its associated factors in rural middle-aged and elderly people with disability.

To analyze the fairness of health service utilization and major associated factors in middle-aged and elderly people with disability in rural mountainous areas of southern Ningxia.

This study used data from three waves of the Rural Household Health Survey (including the baseline survey in 2009 and two follow-up surveys in 2015 and 2019), and selected middle-aged and elderly adults (≥55 years old) with disabilities from the surveyees as the participants. The health service utilization equity of sample population before the new healthcare reform launched in 2009 and during 10 years after the reform was analyzed by using concentration index, and factors affecting the equity were analyzed by decomposing the concentration index.

We selected 1 351 cases from the surveyees of 2009, 1 521 cases from the surveyees of 2015, and 685 cases from the surveyees of 2019. The concentration index for two-week visit rate in the participants was 0.119 9 for 2009, 0.052 1 for 2015, and 0.060 9for 2019. Women (CI=0.108 2, -0.084 1) had higher level of inequalities in heath service utilization than men (CI=-0.022 9, 0.029 5) in 2015, 2019 year. Upper-middle income and high income were major factors contributing to inequalities in health service utilization in this population in 2009, explaining 3.626 9% and 2.596 5% of the inequalities, respectively. In 2015, in addition to economic factors, marital status (married), degree of education (primary) and household size (moderate) were another major factor contributing to inequalities in health service utilization, explaining 0.478 6%、0.398 4%、-0.339 2% of the inequalities, respectively. And in 2019, besides economic factors, household size (advanced) and Age (70-74 years old) were major factor contributing to inequalities in health service utilization, explaining -0.953 4%、0.694 3% of the inequalities, respectively.

Rich-related inequalities were found in the use of care for an ill within two weeks in this group of people, in Ningxia the past decade of the new medical reform. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, household size, economic income, and other factors interact in multiple ways. Moreover, the strength of association age, vocational type inequalities in health service utilization in women was greater than that in men.

随着人口老龄化问题在全球范围内不断加剧，失能人群数量相应增加。失能严重影响居民的生活质量，增加医疗支出负担。国内相关研究多关注中老年人的失能状况，但缺乏对农村失能中老年人卫生服务利用公平性及影响因素变化的纵向研究。

分析宁夏回族自治区南部山区失能中老年人的卫生服务利用公平性，并探究影响公平性的主要影响因素。

基于宁夏回族自治区南部山区"农村居民家庭健康询问调查"2009年基线数据和2015、2019年随访数据，筛选年龄≥55岁的失能中老年人作为研究对象，利用集中指数（CI）分析新医改前后样本人群卫生服务利用公平性变化，通过对CI分解分析影响公平性的因素。

2009、2015、2019年分别纳入失能中老年人1 351、1 521、685例。2009、2015、2019年宁夏回族自治区南部山区失能中老年人两周就诊率的CI分别为0.119 9、0.052 1、0.060 9。新医改政策实施后，失能中老年女性（CI分别为0.108 2、0.084 1）不公平程度较失能中老年男性（CI分别为-0.022 9、0.029 5）更为严重。2009年（新医改政策实施前）影响失能中老年人卫生服务利用公平性的主要贡献因素为中高、高等收入，贡献率分别为2.586 5%、3.626 9%。除经济因素之外，2015年（新医改政策实施后）婚姻状况（在婚）、文化程度（小学）、家庭规模（中规模）也成为主要影响因素，贡献率分别为0.478 6%、0.398 4%、-0.339 2%；2019年家庭规模（大规模）、年龄（70~74岁）也成为主要贡献因素，贡献率分别为-0.953 4%、0.694 3%。

新医改十年间，宁夏回族自治区南部山区失能中老年人卫生服务利用公平性依旧存在亲富性不公平。造成不公平的贡献因素由新医改前单一的经济因素逐渐演变为由年龄、家庭规模、经济因素等多方面因素互相影响的局面。年龄、职业因素对于失能中老年男性公平性的贡献要高于对失能中老年女性的影响。