Abstract: Background　Along with lifestyle and living environment changes as well as accelerated aging，the prevalence of comorbidities among the elderly has gradually become a social problem，putting tremendous pressure on healthcare expenditure.Objective　The purpose of this study was to investigate the prevalence of comorbidity among the elderly，and its impact on healthcare expenditure in China.Methods　We enrolled 5 265 cases aged 60 or over from the participants of China Health and Retirement Longitudinal Study（CHARLS） 2015 and collected their data of sociodemographics，healthcare，chronic disease prevalence and healthcare spending.With healthcare spending as the dependent variable，number of chronic diseases as the independent variable，and sociodemographics and healthcare information as the controllable variables，we developed a multinomial ordered Logit model to explore the impact of number of chronic diseases on healthcare expenditure.Results　About 44.46%（2 341/5 265） of the participants had comorbidity，and the prevalence in urban（48.39%，601/1 242） was significantly higher than that in rural（43.25%，1 740/4 023，P=0.001）.Hypertension plus arthritis or rheumatism was the most common binary combination（16.49%，173/1 049），while hypertension plus stomach or digestive system disease，and arthritis or rheumatism was the most common ternary combination（9.50%，67/705）.The median healthcare expenditures for those with two and three chronic diseases were 600 yuan（QR=2 640） and 1 200 yuan（QR=5 100），respectively.Univariate analysis showed that type of residence，employment status，annual household income per capita ，type of medical insurance，smoking status，BMI，body pain，accidental injury，number of falls，self-rated health status，and number of chronic diseases significantly influenced the distribution of healthcare expenditure（P<0.05）.Ordered Logit model revealed that the number of chronic diseases，highest level of education，employment status，annual household income per capita，type of medical insurance，smoking status，BMI，body pain，and number of falls influenced healthcare expenditure significantly（P<0.05）.Conclusion　The prevalence of comorbidity is high in elderly people in China.The increase in the number of comorbidities can bring about a remarkable increase in healthcare expenditures.To avoid the waste of medical resources，priorities should be given to comprehensive management of comorbidities，and efforts should be made to promote standardized diagnosis and treatment of comorbidities in this group.

Key words: Aged；Comorbidity；Fees, medical；Ordered Logit model

摘要： 背景　随着生活方式、生活环境的改变及老龄化进程的加速，老年人的共病问题已逐渐成为一种社会问题，带来巨大的医疗卫生支出压力。目的　了解我国老年人共病状况，分析共病对医疗卫生支出的影响。方法　基于中国健康与养老追踪调查（CHARLS）2015年全国追访数据，选取5 265例60岁及以上的老年人为研究对象。收集其社会人口学和健康保健相关信息、慢性病患病信息及医疗卫生支出信息，以医疗卫生支出为被解释变量，以患慢性病数量为解释变量，以社会人口学和健康保健相关信息为控制变量，建立多元定序Logit模型，分析患慢性病数量对医疗卫生支出的影响。结果　老年人的共病患病率为44.46%（2 341/5 265），城镇（48.39%，601/1 242）高于农村（43.25%，1 740/4 023），差异有统计学意义（P=0.001）。高血压+关节炎或风湿病是最常见的二元疾病组合（16.49%，173/1 049），高血压+胃部或消化系统疾病+关节炎或风湿病是最常见的三元疾病组合（9.50%，67/705）。患2种和3种慢性病患者的中位医疗卫生支出分别为600（2 640）元和1 200（5 100）元；单因素分析显示，不同居住地、就业状态、家庭人均年收入水平、医疗保险类型、吸烟情况、BMI、身体疼痛、意外伤害、跌倒次数、自评健康状况、患慢性病数量老年人的医疗卫生支出比较，差异有统计学意义（P<0.05）；定序Logit模型结果显示，患慢性病数量、最高学历、就业状态、家庭人均年收入水平、医疗保险类型、吸烟状态、BMI、身体疼痛、跌倒次数是老年人医疗卫生支出的影响因素（P<0.05）。结论　我国老年人的共病患病率高，共病数量的增加会导致医疗卫生支出的明显增长；应重视老年人共病的综合管理，推进共病规范化诊疗，减少不必要的医疗资源浪费。

关键词: 老年人, 共病现象, 费用, 医疗, 定序Logit模型