集中指数分解在慢性病患病和就诊公平性评价中的应用  

Sociodemographic Inequalities in the Prevalence and Treatment of Chronic Non-communicable Diseases:a Concentration Index Decomposition Analysis

作　　者：吴騻 何利平 李晓梅 喻箴 孟金良 母凤婷 WU Shuang;HE Liping;LI Xiaomei;YU Zhen;MENG Jinliang;MU Fengting(Department of Epidemiology and Health Statistics,School of Public Health,Kunming Medical University,Kunming 650500,China)

机构地区：[1]昆明医科大学公共卫生学院流行病与卫生统计学教研室,云南省昆明市650500

出　　处：《中国全科医学》2020年第22期2841-2846,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81160364)——卫生服务公平性评价及其在云南省的应用研究;与耶鲁大学合作项目(42015009)——云南省女性健康公平性和卫生服务利用公平性研究。

摘　　要：背景慢性非传染性疾病已成为全球重要的公共卫生问题之一。我国慢性病患者不断增加,慢性病导致的死亡占总死亡人数的比重较大,但有关慢性病患病和就诊不公平性来源的研究较少。目的评价云南省昭通市农村居民慢性病患病和就诊的公平性,为改善人群健康水平及制定相关措施提供依据。方法2013年7—11月通过多阶段分层整群随机抽样抽取昭通市3个地区(昭阳区、鲁甸县及盐津县)的9988名常住农村居民,入户进行面对面问卷调查。调查内容包括家庭基本情况、家庭成员社会人口学特征、家庭成员过去1年慢性病患病情况及慢性病就诊情况等。农村居民慢性病患病和就诊的公平性采用集中指数(CI)及其分解进行分析。结果昭通市农村居民的慢性病患病率及就诊率分别为15.75%(1573/9988)、13.02%(1300/9988)。影响慢性病患病率CI的主要变量为人均收入水平、年龄、婚姻状况,贡献率分别为-130.57%、43.03%、20.95%;影响慢性病就诊率CI的主要变量为人均收入水平、年龄、是否有医保、婚姻状况,贡献率分别为-99.77%、37.49%、30.48%、27.48%。标化后的慢性病患病和就诊结果的CI分别为-0.1154、-0.1182,呈倾贫性。结论昭通市农村居民慢性病患病和就诊情况存在倾贫性不公平。造成慢性病患病和就诊水平不公平的第一位贡献因素是收入水平,第二位贡献因素是年龄。Background Chronic non-communicable diseases have become one of the significant public health problems in the world.In China,chronic disease patients are increasing,and the rate of all deaths due to such diseases is high,but the sources of inequalities in the prevalence and treatment of chronic diseases are rarely studied.Objective To evaluate the inequalities in the prevalence and treatment of chronic diseases in rural residents from Zhaotong,Yunnan Province,providing a basis for the development of population health promotion strategies.Methods A household questionnaire survey was conducted between July and November,2013,in 9988 permanent rural residents from three areas(Zhaoyang District,Ludian County and Yanjin County)of Zhaotong City,selected by multistage cluster sampling and stratified sampling,for collecting basic family status,sociodemographic characteristics of family members,prevalence and treatment of chronic diseases in family members in the past year,and so on.Concentration index(CI)and CI decomposition were used to analyze the sociodemographic inequalities in the prevalence and treatment of chronic diseases.Results The prevalence of chronic diseases in this group of rural residents was 15.75%(1573/9988),and the treatment rate was 13.02%(1300/9988).The main variables influencing the CI of chronic disease prevalence were annual household income per capita,age and marital status,with the contribution rate of-130.57%,43.03%and 20.95%respectively;the main variables influencing the CI of chronic disease visit rate were annual household income per capita,age,whether there was medical insurance or not,and marital status,with the contribution rate of-99.77%,37.49%,30.48%and 27.48%respectively.The standardized CIs for the prevalence and treatment of chronic diseases were-0.1154,-0.1182,respectively,showing that the prevalence and treatment of chronic diseases were more common among low-income individuals.Conclusion The findings indicated that there were sociodemographic inequalities in chronic disease prevale

关 键 词：慢性病 资源配置 公平性 集中指数分解 

分 类 号：R195[医药卫生—卫生统计学]