Scholarlink

Background <p>Population aging on the Tibetan Plateau may marginalize older women through combined gender and age bias. We measured sex-specific gaps in medical spending and service use across the life course. We tested whether gendered ageism appears in midlife and grows thereafter.</p> Methods <p>We analyzed 1,274,491 person-year health insurance reimbursement claims data in three major Tibetan cities (2021–2023). We examined four outcomes: annual total medical expenditure, outpatient visits, inpatient admissions, and tertiary-hospital admissions. The key exposure was sex. Age was divided into seventeen five-year groups. We applied LASSO to prevent multicollinearity. We then estimated two-way fixed-effects models. These models controlled for Andersen’s predisposing, enabling, and need covariates. We clustered errors at the person level.</p> Results <p>Women’s spending gap appeared at ages 36–40 (β = − 299; 95% CI: − 425 to − 123). This gap represented roughly an 8% lower annual expenditure compared with men. The maximum deficit occurred at ages 71–75 (β = − 1,006; 95% CI: − 1,401 to − 610), with women spending 28% less than men. Women’s outpatient advantage peaked at ages 31–35 (β = 0.58; 95% CI: 0.54 to 0.61). This advantage faded after age 70. In the inpatient admissions model, women first showed a significant advantage at age 31–35 (β = 0.02 admissions). From age 46–50 through 61–65, this advantage ranged from 0.03 to 0.05 admissions. From age 36–40 onward, women had fewer tertiary-hospital admissions than men (β = − 0.01). This deficit persisted across all later age bands.</p> Conclusions <p>Gendered ageism emerges 30 years earlier than the conventional “65-plus” threshold. It accelerates through midlife and peaks in late old age among Tibetan women. Early policy action could interrupt this cumulative inequity. We recommend higher URRBMI reimbursement, “Plateau-Women-First” telemedicine channels, and flexible delayed retirement with pension top-ups. These measures would support gender-sensitive healthy aging.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

From midlife emergence to old-age divergence: an empirical study on structural gendered ageism in health service utilization in Tibet

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月23日

查看全文
  • Changli Jia,
  • Weizhuo Chen,
  • Xiang Zhang

摘要

Background

Population aging on the Tibetan Plateau may marginalize older women through combined gender and age bias. We measured sex-specific gaps in medical spending and service use across the life course. We tested whether gendered ageism appears in midlife and grows thereafter.

Methods

We analyzed 1,274,491 person-year health insurance reimbursement claims data in three major Tibetan cities (2021–2023). We examined four outcomes: annual total medical expenditure, outpatient visits, inpatient admissions, and tertiary-hospital admissions. The key exposure was sex. Age was divided into seventeen five-year groups. We applied LASSO to prevent multicollinearity. We then estimated two-way fixed-effects models. These models controlled for Andersen’s predisposing, enabling, and need covariates. We clustered errors at the person level.

Results

Women’s spending gap appeared at ages 36–40 (β = − 299; 95% CI: − 425 to − 123). This gap represented roughly an 8% lower annual expenditure compared with men. The maximum deficit occurred at ages 71–75 (β = − 1,006; 95% CI: − 1,401 to − 610), with women spending 28% less than men. Women’s outpatient advantage peaked at ages 31–35 (β = 0.58; 95% CI: 0.54 to 0.61). This advantage faded after age 70. In the inpatient admissions model, women first showed a significant advantage at age 31–35 (β = 0.02 admissions). From age 46–50 through 61–65, this advantage ranged from 0.03 to 0.05 admissions. From age 36–40 onward, women had fewer tertiary-hospital admissions than men (β = − 0.01). This deficit persisted across all later age bands.

Conclusions

Gendered ageism emerges 30 years earlier than the conventional “65-plus” threshold. It accelerates through midlife and peaks in late old age among Tibetan women. Early policy action could interrupt this cumulative inequity. We recommend higher URRBMI reimbursement, “Plateau-Women-First” telemedicine channels, and flexible delayed retirement with pension top-ups. These measures would support gender-sensitive healthy aging.