Objective To study the role of gender and marital status as risk factors for nursing home entry in the United States. Method The paper uses data from the Health and Retirement Study, a nationally representative survey of the older population in the United States. Multivariate logit models of the risk of nursing home entry over a 2-year follow-up period were estimated for noninstitutionalized individuals over the age of 65. A multiple imputation procedure was used to explore the sensitivity of the results to alternative assumptions about the data-generating process of missing outcome values. Results In an analysis based on complete observations, women exhibited the same risk of nursing home entry as men (risk ratio [RR] = 1.01; CI: 0.90, 1.13). However, after expanding the sample to include information on nursing home use for individuals who died during the follow-up period, women were found to have a statistically lower risk of nursing home entry (RR = 0.85; CI: 0.79, 0.92). The latter result was robust to alternative assumptions about the nature of missing data. The type of sample used in the analysis did not affect the conclusions regarding the role of marital status. Divorced and widowed individuals were found to be at higher risk of nursing home admissions than married individuals in all specifications. Discussion The findings clarify the role of gender as a predictor of nursing home admissions and may provide useful prognostic information for clinicians and caregivers regarding nursing home entry risk. The study also sheds light on how conclusions about predictors of nursing home risk obtained from prospective studies with long follow-up periods can be affected by the treatment of missing outcomes due to death or attritions.

中文翻译：

---

重新审视性别和婚姻状况作为进入疗养院的风险因素的作用

目的研究性别和婚姻状况作为进入美国疗养院危险因素的作用。方法 本文使用来自健康与退休研究的数据，这是一项针对美国老年人口的全国代表性调查。对 65 岁以上的非住院个体在 2 年的随访期内进入疗养院风险的多变量 logit 模型进行了估计。使用多重插补程序来探索结果对数据的替代假设的敏感性——产生缺失结果值的过程。结果 在基于完整观察的分析中，女性进入疗养院的风险与男性相同（风险比 [RR] = 1.01；CI：0.90，1.13）。然而，在扩大样本以包括在随访期间死亡的个人使用疗养院的信息后，发现女性进入疗养院的风险在统计学上较低（RR = 0.85；CI：0.79, 0.92）。后一个结果对于关于缺失数据性质的替代假设是稳健的。分析中使用的样本类型不影响关于婚姻状况作用的结论。在所有规格中，发现离婚和丧偶的人进入疗养院的风险高于已婚的人。讨论 研究结果阐明了性别作为疗养院入院预测因素的作用，并可能为临床医生和护理人员提供有关疗养院进入风险的有用预后信息。