《保险研究》20250405-《基于IRT模型的中国老年人失能次序和失能分级研究》（蒋鑫钰、王晓军）

［摘   要］对于老年人失能进展和失能分级的研究，既有文献一般依据日常活动限制（ADL）项目的数量对失能程度进行分级，很少关注活动限制项目发生的先后顺序、难易程度和时间间隔问题。本文引入项目反应理论（IRT）模型，基于中国老年健康影响因素跟踪调查（CLHLS）数据，对ADL项目的失能次序进行建模，发现从洗澡到穿衣、如厕、上下床以及进食和控制排泄等一般失能次序的进展规律，进而给出纳入失能次序信息的新的失能分级指标，并采用加速失效时间模型和多状态Markov模型等分析结果，对失能分级指标的合理性进行佐证，将研究结果用于对不同等级失能持续期和长期护理保险给付成本的测算。本研究可以为完善失能分级，合理配置失能护理时间，优化长期护理服务和长期护理保险制度提供参考。

［关键词］IRT模型；失能次序；失能分级；失能持续时间；长期护理保险

［基金项目］本文受到教育部哲学社会科学研究重大课题攻关项目“健康中国2030背景下的健康老龄化体系优化研究”（20JZD023）的支持。

［作者简介］蒋鑫钰，中国人民大学统计学院博士研究生;王晓军（通讯作者），中国人民大学应用统计科学研究中心研究员、统计学院教授。

A Study on the Disability Hierarchy and Disability Classification of Chinese Elderly People Based on IRT Model

JIANG Xin-Yu，WANG Xiao-Jun

Abstract：Regarding the study of disability progression and disability classification of the elderly，existing literature generally classifies the degree of disability based on the number of daily activity limitations （ADL） items，and rarely pays attention to the disability hierarchy，difficulty of the ADL items and the time interval of them.This paper introduces the item response theory （IRT） model and models the loss hierarchy of ADL items based on the data of the China Health Influencing Factors Follow-up Survey （CLHLS）.It discovers the progression law of the general disability order from bathing to dressing，toileting，transferring，eating and continence，and suggests to incorporate the disability hierarchy order and a new disability classification index.Furthermore，the analysis results of accelerated failure time model and multi-state Markov model are used to verify the rationality of the disability classification index，and finally used to calculate the duration of disability of different levels and the payment cost of long-term care insurance.The research results of this paper can provide a reference for optimizing disability classification，rationally allocating disability care time， and optimizing long-term care services and long-term care insurance system.

Key words：IRT;disability hierarchy;disability classification;disability duration;long-term care insurance