我国中老年慢性病患者卫生服务利用现况及影响因素分析

doi:10.3969/j.issn.1006-3110.2019.05.011

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摘要目的分析我国中老年慢性病患者卫生服务利用水平的现况及影响因素,为提高卫生服务利用水平提供参考意见。方法从中国健康与养老追踪调查2015年的随访数据中筛选6 952例中老年慢性病患者,运用统计描述、χ²检验、Logistic回归模型分析其卫生服务利用的现况及影响因素。结果中老年慢性病患者四周就诊率为24.14%,一年住院率为17.69%。logistic回归结果显示:性别(参考:女性,男性OR=0.79,95%CI:0.70~0.88)、自评健康状况(参考:差,优OR=0.31,95%CI:0.21~0.46;良OR=0.37,95%CI:0.28~0.49;中OR=0.55,95%CI:0.47~0.64;较差OR=0.66,95%CI:0.57~0.76)、抑郁状况(参考:差,优OR=0.55,95%CI:0.45~0.67;中OR=0.73,95%CI:0.60~0.90)、家庭总收入(参考:低收入,中等收入OR=1.20,95%CI:1.05~1.37;高收入OR=1.49,95%CI:1.19~1.87)对四周就诊率有影响;居住地(参考:农村,城市OR=1.42,95%CI:1.17~1.72;城乡结合部OR=1.34,95%CI:1.12~1.61)、年龄(参考:45~岁,50~岁OR=1.10,95%CI:0.89~1.35;60~岁OR=1.41,95%CI:1.15~1.73;70~岁OR=1.79,95%CI:1.44~2.22)、受教育程度(参考:小学及以下,初中OR=1.15,95%CI:0.98~1.35;高中OR=1.31,95%CI:1.06~1.63;大学及以上OR=0.90,95%CI:0.61~1.33)、自评健康状况(参考:差,优OR=0.27,95%CI:0.17~0.42;良OR=0.20,95%CI:0.14~0.28;中OR=0.32,95%CI:0.27~0.39;较差OR=0.47,95%CI:0.40~0.55)、抑郁状况(参考:差,优OR=0.73,95%CI:0.58~0.93;中OR=0.89,95%CI:0.70~1.12)、医疗服务满意度(参考:非常不满意,非常满意OR=1.61,95%CI:1.20~2.15;有点满意OR=1.59,95%CI:1.22~2.07;中立OR=1.24,95%CI:0.96~1.60;有点不满意OR=1.28,95%CI:0.96~1.70)、身体功能状况(参考:无障碍,有一些障碍OR=0.47,95%CI:0.24~0.93;严重障碍OR=0.81,95%CI:0.40~1.64)对一年住院率有影响。结论我国中老年慢性病患者卫生服务利用的水平整体较高,但在性别、居住地、年龄、受教育程度、自评健康状况、抑郁状况、医疗服务满意度、身体功能状况、家庭总收入等变量之间存在差异。基层卫生机构要对中老年慢性病患者进行健康教育、心理疏导和康复训练,同时关注男性患者、受教育程度较低患者的就诊和住院情况。政府部门要积极推进城镇化建设,增加居民收入,改善就医环境。

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	李树峰
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	王晴
	闻海

关键词 ：慢性病, 中老年人, 卫生服务利用, 影响因素

Abstract：Objective To analyze the current status and influencing factors of health services utilization among middle-aged and elderly patients in China, and to provide references for improving health service utilization. Methods A total of 6,952 middle-aged and elderly patients with chronic diseases were extracted from the database of China Health and Retirement Longitudinal Study conducted in 2015. Statistical description, χ²-test and multivariate logistic regression were performed to analyze the current status of health services utilization and its influencing factors. Results The four-week outpatient rate in the middle-aged and elderly patients with chronic diseases was 24.14%, and the one-year hospitalization rate was 17.69%. Multivariate logistic regression analysis indicated that gender (reference: female, male OR=0.79, 95%CI:0.70-0.88), self-rated health status (reference: poor, excellent OR=0.31, 95%CI:0.21-0.46; good OR=0.37, 95%CI:0.28-0.49; middle OR=0.55, 95%CI:0.47-0.64; somewhat poor OR=0.66, 95%CI:0.57-0.76), depression status (reference: poor, excellent OR=0.55, 95%CI:0.45-0.67; middle OR=0.73, 95%CI:0.60-0.90) and household income (reference: low, medium OR=1.20, 95%CI:1.05-1.37;high income OR=1.49, 95%CI:1.19-1.87) were the factors influencing the four-week outpatient rate. Residence (reference: rural area, urban area OR=1.42, 95%CI:1.17-1.72; suburb area OR=1.34, 95%CI:1.12-1.61), age (reference: 45- years old, 50- years old OR=1.10, 95%CI:0.89-1.35; 60- years old OR=1.41, 95%CI:1.15-1.73; 70- years old OR=1.79, 95%CI:1.44-2.22), education background (reference: elementary school or below, middle school OR=1.15, 95%CI:0.98-1.35; high school OR=1.31, 95%CI:1.06-1.63; college degree or above OR=0.90, 95%CI:0.61-1.33), self-rated health status (reference: poor, excellent OR=0.27, 95%CI:0.17-0.42; good OR=0.20, 95%CI:0.14-0.28; middle OR=0.32, 95%CI:0.27-0.39; somewhat poor OR=0.47, 95%CI:0.40-0.55), depression status (reference: poor, excellent OR=0.73, 95%CI:0.58-0.93; middle OR=0.89, 95%CI:0.70-1.12), health service satisfaction (reference: very unsatisfactory, very satisfactory OR=1.61, 95%CI:1.20-2.15; somewhat satisfactory OR=1.59, 95%CI:1.22-2.07; neutral OR=1.24, 95%CI:0.96-1.60; somewhat unsatisfactory OR=1.28, 95%CI:0.96-1.70), physical function status (reference: no difficulty, some difficulties OR=0.47, 95%CI:0.24-0.93; difficulty OR=0.81, 95%CI:0.40-1.64) were the factors influencing the one-year hospitalization rate. Conclusions The level of health services utilization of middle-aged and elderly patients with chronic non-communicable diseases in China is generally high, but there are differences among variables such as gender, residence, age, education background,self-rated health status, depression status, health services satisfaction, physical function status and total household income. Primary health care facilities should carry out health education, psychological counseling and rehabilitation training for the middle-aged and elderly patients, and pay more attention to the status of medical check-up and hospitalization in male and less-educated patients. The authorities should push forward the urbanization, increase the income of residents and optimize the medical environment.

Key words： chronic non-communicable diseases the middle-aged and elderly health services utilization influencing factor

收稿日期: 2018-11-06

R161.7

作者简介: 李树峰(1989-),男,山西朔州人,硕士,主要从事慢性病的健康管理和卫生政策研究工作。

引用本文:

李树峰, 严晓玲, 付翰林, 别凤赛, 王晴, 闻海. 我国中老年慢性病患者卫生服务利用现况及影响因素分析[J]. 实用预防医学, 2019, 26(5): 550-554. LI Shu-feng, YAN Xiao-ling, FU Han-lin, BIE Feng-sai, WANG Qing, WEN Hai. Current status of health service utilization and its influencing factors amongmiddle-aged and elderly patients with chronic non-communicable diseases in China. , 2019, 26(5): 550-554.

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https://www.syyfyx.com/CN/10.3969/j.issn.1006-3110.2019.05.011 或 https://www.syyfyx.com/CN/Y2019/V26/I5/550

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