Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model

China is undergoing great social changes, and its demographic makeup is shifting every year along with those changes. China released key indicators from the seventh national population census on 12 May 2021. The total population of China's mainland increased to 1.41178 billion in 2020 from 1.33972 billion in 2010 (sixth national population census) with an average annual growth rate of 0.53%. In the past 10 years, the share of the population aged above 60 and 65 years increased by 5.44% (from 13.26% in 2010 to 18.70% in 2020) and 4.6% (from 8.9 to 13.5%), respectively. The share of the population with a college education or above rose from 8.93% in 2010 to 15.47% in 2020, and the illiteracy rate dropped from 4.08% in 2010 to 2.67% in 2020. In the next decade, China is likely to face many changes, including the increasing proportion of older adults in the population, declining births, and economic transformation. In an effort to respond to the changed demographic landscape, the authorities should adopt new laws and strategies to improve government services for older adults and consider ways to support women and families and make childbearing more attractive to and feasible for women.

Background In response to China’s rapidly aging population and increasing healthcare service demands, the Chinese government is developing a universal medical insurance system. This study aimed to assess healthcare utilization patterns and analyze the impacts of medical insurance schemes on healthcare utilization among the middle-aged and elderly in China. Methods Data was extracted from the China Health and Retirement Longitudinal Study in 2011, 2013 and 2015. Healthcare utilization was measured by outpatient and inpatient service utilization. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on healthcare utilization. The factors associated with healthcare utilization were estimated using a random-effects logistic regression model. Results During the study period, the number of individuals involved was 17,250, 18,195 and 19,842, respectively. The proportion of individuals who received outpatient service was 18.6, 20.7 and 18.7% and those who used inpatient service was 9.6, 13.8 and 14.3%, respectively. We identified that medical insurance was a major protective factor for improving healthcare utilization but different medical insurance schemes exerted various impacts on the middle-aged and the elderly. Conclusions Despite the growing population coverage, the Chinese government should make every effort to bridge the gap among people with different medical insurance schemes. Further evaluation is needed to assess whether the expanded medical insurance schemes could protect the middle-aged and elderly households from catastrophic health expenditure.