Abstract: Background　Fast population ageing leads to the increasing prevalence of chronic diseases in middle-aged and elderly people，which brings a heavy economic burden to both the patients and their families.Concurrently，poor chronic disease management and fair treatment compliance have been found in these populations.Moreover，nonuse of the needed services has also been identified in some individuals in these groups.Objective　Investigation the status of nonuse of health services in middle-aged and elderly chronic disease people，and to analyze whether the use of such health services is inequitable in middle-aged and elderly individuals with chronic disease.Methods　The research was conducted in February，2018.Demographic and economic characteristics，use of healthcare services，health status and functional indicators and other data about middle-aged and elderly people stemmed from the China Health and Retirement Longitudinal Study 2013.Health services（including outpatient，inpatient and physical examination services） that were not used were the dependent variables.Multivariate Logistic regression was applied to identity factors associated with nonuse of the abovementioned services in middle-aged and elderly people.Concentration indices were calculated and adopted to evaluate the equity in the use of such services in chronic disease groups by economic level.Results　 A total of eligible 4 509 individuals were included，of which 3 274（72.61%） suffered from chronic diseases.Among patients with chronic diseases，the prevalence rates of nonuse of outpatient，inpatient，and physical examination services were 20.62%（675/3 274），5.47%（179/3 274），and 60.11%（1 968/3 274），respectively.Individuals with chronic disease showed higher rates of nonuse of outpatient and inpatient services，and lower rate of nonuse of physical examination services compared with those without（P<0.05）．Among all the participants，age，employment/retirement status，annual household income per capita，residence，self-reported health status，chronic disease prevalence，depression prevalence，and ADL were factors influencing non-use of outpatient services（P<0.05）；employment/retirement status，self-reported health status，and BMI were influencing factors of non-use inpatient service（P<0.05）；age，education level，number of family members，social insurance enrollment status，annual household income per capita，residence，chronic disease prevalence and smoking status were associated with non-use physical examination services（P<0.05）．In individuals with chronic disease，nonuse of outpatient services was found mainly in those with high annual household income per capita（CI=0.022），while nonuse of inpatient and physical examination services were found mainly in those with low annual household income per capita（CI were -0.060，-0.048）．Conclusion　In middle-aged and elderly people with chronic disease，nonuse of physical examination services is affected by various factors，and nonuse of health services is mainly affected by social-economic factors.In view of this，recommended facilitation strategies for promoting equitable and rational distribution and effective use of healthcare resources，reducing nonuse of health services，and realizing equitable healthcare are as follows：the awareness of chronic disease prevention and treatment in middle-aged and elderly people should be increased，government agencies are suggested to develop new models and further improve the existing models for delivering hierarchical medical services，to incentivize residents to seek healthcare in primary care，and to train general practitioners，as well as to give differential reimbursement to middle-aged and elderly people with chronic disease.

Key words: Health care rationing, Health services accessibility, Chronic disease, Middle aged, Aged

摘要： 背景　人口老龄化加剧，中老年人群中慢性病罹患率持续增加，给个人和家庭带来沉重经济负担，且目前中老年慢性病患者症状管理较差、依从性一般，部分中老年人群中出现有卫生服务“需要”却“未利用”的现象。目的　了解中老年慢性病人群卫生服务未利用状况，并分析其卫生服务未利用的公平性。方法　于2018年2月，在2013年中国健康与养老追踪调查（CHARLS）数据中，选取中老年人（≥45岁）的人口经济学特征、医疗卫生服务利用情况、健康状况和功能等指标。以卫生服务未利用（包括门诊服务未利用、住院服务未利用、体检服务未利用）为因变量，采用多因素Logistic回归分析中老年人群卫生服务未利用的影响因素，计算集中指数（CI）分析中老年慢性病人群不同经济水平的卫生服务未利用公平性。结果　共纳入符合要求的中老年人4 509例，其中3 274例（72.61%）患慢性病。中老年慢性病患者的门诊服务未利用、住院服务未利用发生率分别为20.62%（675/3 274）、5.47%（179/3 274），高于无慢性病者（P<0.05）；中老年慢性病患者的体检服务未利用发生率为60.11%（1 968/3 274），低于无慢性病者（P<0.05）。多因素Logistic回归分析结果显示，年龄、就业/退休状态、收入水平、居住地区、自报健康状况、患慢性病情况、抑郁状况、日常生活活动能力（ADL）是中老年人门诊服务未利用的影响因素（P<0.05）；就业/退休状态、自报健康状况、BMI是中老年人住院服务未利用的影响因素（P<0.05）；年龄、教育程度、家庭人口数、社会医疗保险、收入水平、居住地区、患慢性病情况、吸烟情况是中老年人体检服务未利用的影响因素（P<0.05）。中老年慢性病人群的门诊服务未利用集中在高收入人群（CI=0.022），住院服务和体检服务未利用集中在低收入人群（CI分别为-0.060、-0.048）。结论　中老年人群的体检服务未利用受多种因素影响，社会经济因素是影响卫生服务未利用的重要因素。中老年人群应提高慢性病防治意识；政府部门应进一步建立健全分级诊疗模式、鼓励基层就诊，培养全科医生，并针对中老年慢性病人群进行差异化补偿，促进医疗卫生资源公平合理配置和有效利用，减少卫生服务未利用现象，实现健康公平。

关键词: 卫生保健公平提供, 卫生服务易得程度, 慢性病, 中年人, 老年人