【摘要】 目的 了解慢性病共病对中国老年人就医机构选择行为的影响，为优化就医秩序、增强基层慢性病管理能力提供理论依据。方法 收集2020年中国家庭追踪调查数据（CFPS）中4 508名≥60岁老年人的相关数据，应用Stata 17.0统计软件采用Probit回归模型和倾向得分匹配（PSM）方法分析慢性病共病对中国老年人就医机构选择行为的影响。结果 中国4 508名≥60岁老年人中，慢性病共病者748例，慢性病共病率为16.59%；选择基层医疗机构就医者2 536人（56.26%），选择非基层医疗机构就医者1 972人（43.74%）。在控制了性别、年龄、文化程度、婚姻状况、户籍类型、月退休金、就医满意度、是否参加医疗保险、与子女的感情、子女是否提供经济支持、子女是否提供照料支持、自评健康状况、健康变化情况、近2周是否身体不适和是否能自我照顾等倾向、使能、需求因素后，Probit回归分析结果显示，中国慢性病共病老年人更倾向于选择非基层医疗机构就医（β=–0.130,95%CI=–0.237～–0.022）；慢性病共病对老年人就医选择的平均处理效应估计结果显示，使用K近邻匹配、核匹配和半径匹配3种方法进行匹配的ATT值分别为–0.052、–0.048和–0.047（均P <0.05），慢性病共病可降低老年人到基层医疗机构的就医概率；异质性检验结果显示，慢性病共病对女性（ATT=–0.078～–0.063，均P <0.05）和初中及以下文化程度（ATT=–0.058～–0.052，均P <0.05）老年人的影响更为显著，但对男性和高中及以上文化程度老年人的影响差异均无统计学意义（均P> 0.05）。结论 慢性病共病会在一定程度上影响中国老年人就医机构的选择行为，且在不同性别和文化程度老年人中的影响存在差异。更多还原

【Abstract】 Objective To understand the impact of chronic disease comorbidity on healthcare institution-seeking behavior of elderly people in China, and to provide a theoretical basis for optimizing healthcare order and enhancing the management capacity of primary care for chronic diseases. Methods The data on 4 508 elderly people aged ≥ 60 years in 25 provincial-level administrative divisions across China were collected from the China Family Panel Studies(CFPS)conducted in 2020. The Stata 17.0 statistical software was used to analyze the impact of chronic disease comorbidity on healthcare facility-seeking behavior of elderly people in China using the probit regression model and the propensity score matching(PSM) method. Results Of the 4 508 elderly people surveyed, 748(16.59%) reported having chronic disease comorbidity(suffering from two or more chronic diseases); 2 536(56.26%) and 1 972(43.74%) reported seeking medical treatment at primary and non-primary healthcare institutions during past six months. After adjusting for predisposing factors(gender, age, education level, marital status), enabling factors(household registration type, monthly retirement pension, satisfaction with medical treatment, participation in medical insurance, emotional relationship with children,financial support from children, caregiving provided by children), and need factors(self-rated health status, changes in health conditions, physical discomfort in the past two weeks, the ability to take care of oneself), the results of probit regression analysis showed that the elderly people with comorbid chronic diseases were more inclined to seek medical treatment at non-primary healthcare institutions(β = – 0.130, 95% confidence interval: – 0.237 – – 0.022). The estimated values of average treatment effect on the treated(ATT) of chronic disease comorbidity on the healthcare institution selection of the elderly people were – 0.052, – 0.048, and – 0.047, respectively, based on matched propensity scores of predisposing, enabling, and need factors with K-nearest neighbor, kernel, and radius matching(all P < 0.05), indicating that chronic disease comorbidity can reduce the probability of elderly people seeking medical treatment at primary healthcare institutions. The heterogeneity test results showed that the impact of chronic disease comorbidity on females(ATT = – 0.078 – – 0.063, all P < 0.05) and the elderly people with a junior high school education or below(ATT =– 0.058 – – 0.052, all P < 0.05) was more significant, but there was no statistically significant difference in the impact on males and elderly people with a high school education or above(all P > 0.05). Conclusion Chronic disease comorbidity may affect the selection of medical institutions for elderly people in China to some extent, and its influence differs by gender and education level of the elderly.更多还原