健康发展与政策研究2025，Vol.28Issue(3)：283-293,11.DOI:10.12458/HDPR.202501043
中国中老年人童年逆境与灾难性卫生支出的关联分析
Association analysis between adverse childhood experiences and catastrophic health expenditure among middle-aged and older adults in China
摘要
Abstract
Objective To explore the association between adverse childhood experiences(ACEs)and catastrophic health expenditure(CHE)among middle-aged and older adults in China,and to analyze the mediating role of health status(self-rated health,chronic diseases,depression,and cognitive function)in the association.Methods The data was sourced from four phases of the China Health and Retirement Longitudinal Study(CHARLS)in 2011,2013,2015,and 2018,as well as the Chinese Resident Life Course Special Survey in 2014.A generalized estimating equations model was used to analyze the association between different types of ACEs and CHE,identify the potential mediating factors,and further conduct gender subgroup analysis.Results Individuals who experienced ACEs had a higher risk of CHE(P＜0.05).When the self-rated health scores,chronic disease,depression scores,and cognitive function scores were added to the model,the association between 3 types of ACEs(socioeconomic disadvantage,parental trauma,and parenting behavior trauma)and CHE significantly decreased,reflecting the mediating role of health status in the association.The results of gender subgroup analysis indicated that women were more susceptible to socioeconomic disadvantage(OR=1.09,95%CI:1.03～1.15),while men were more susceptible to parenting related behavioral trauma(OR=1.11,95%CI:1.03～1.20).Conclusions ACEs exacerbated the risk of CHE,with health status(self-rated health,chronic diseases,depression,and cognitive function)playing a mediating role,and it emphasized the importance of multi-party collaboration among government,society,schools,and families,as well as interventions such as mental health support and chronic disease management.The study provides empirical evidence for formulating targeted policies and intervention measures.关键词
童年逆境/灾难性卫生支出/自评健康/慢性病/抑郁/认知功能/性别差异/中老年人Key words
adverse childhood experiences/catastrophic health expenditure/self-rated health/chronic diseases/depression/cognitive function/gender differences/middle-aged and older adults分类
医药卫生引用本文复制引用
赵苗苗,王雪纯,丁若溪,张伟波,蔡军..中国中老年人童年逆境与灾难性卫生支出的关联分析[J].健康发展与政策研究,2025,28(3):283-293,11.基金项目
国家自然科学基金委员会青年科学基金项目(71603006) （71603006）
上海市"医苑新星"青年医学人才培养资助计划(沪卫人事[2024]70号) （沪卫人事[2024]70号）
上海市加强公共卫生体系建设三年行动计划学科带头人项目(GWVI-11.2-XD25) （GWVI-11.2-XD25）
