我国流动老年人公共卫生服务利用及健康公平性研究  

Public Health Service Utilization and Health Equity among Elderly Migrants in China

作　　者：闵淑慧 胡依 成晓芬 郭芮绮 李贝 MIN Shuhui;HU Yi;CHENG Xiaofen;GUO Ruiqi;LI Bei(School of Health Management,Southern Medical University,Guangzhou 510515,China;Shenzhen Health Development Research and Data Management Center,Shenzhen 518028,China)

机构地区：[1]南方医科大学卫生管理学院,广东省广州市510515 [2]深圳市卫生健康发展研究和数据管理中心,广东省深圳市518028

出　　处：《中国全科医学》2023年第16期1938-1945,共8页Chinese General Practice

基　　金：2020年广东省自然基金项目(2020A1515011134)——珠三角城市流动老人社会融合度测量模型与干预路径研究;2020年广州市哲学社会科学发展“十三五”规划项目(2020GZGJ130);2022年卫生管理学院国家级课题培育计划项目(2022RFT005)。

摘　　要：背景我国流动老年人规模不断增大,“年龄”和“流动”的双重弱势导致其存在健康脆弱风险和公共卫生服务利用低的问题。目前,针对流动老年人与收入相关公共卫生服务和健康不公平的研究相对较少。目的了解流动老年人的公共卫生服务利用情况和健康状况,评价其公共卫生服务利用和健康公平性,为减少与收入相关的卫生不平等情况提供建议。方法于2022年4月,从2018年全国流动人口卫生计生动态监测调查数据库(CMDS 2018)中选取年龄≥60岁的老年流动人口为研究对象(n=5840)。以健康教育、健康档案、家庭医生服务利用情况反映流动老年人的公共卫生服务利用情况,以自评健康、近1年患病情况反映流动老年人的健康状况,同时收集流动老年人的社会人口学、经济学特征及流动特征作为解释变量。采用修正集中指数(EI)衡量流动老年人公共卫生服务利用和健康状况与收入相关的不平等程度,采用基于Logit模型的分解分析量化每个决定因素对总不公平的贡献。结果流动老年人的健康教育接受率为72.12%(4212/5840),EI=0.021(P>0.05);健康档案建立率为30.99%(1810/5840),EI=-0.054(P<0.05);家庭医生签约率为16.83%(983/5840),EI=-0.057(P<0.05)。自评健康良好者占82.29%(4806/5840),EI=0.199(P<0.05);近1年患病者占29.02%(1695/5840),EI=0.123(P<0.05)。EI分解结果显示:对公共卫生服务利用不公平贡献最高的因素为家庭人均月收入(对健康档案、家庭医生服务利用的贡献率分别为74.354%、53.383%),其次为流动范围(对健康档案、家庭医生服务利用的贡献率分别为43.474%、32.063%);对健康状况不公平贡献率最高的因素亦为家庭人均月收入(对自评健康、近1年患病情况的贡献率分别为59.561%、66.641%),其次为户籍类型对自评健康的影响(贡献率为36.347%),流动范围对近1年患病情况的影响(贡献率为14.153%)。结论流动老年人公�Background The increasing elderly floating people in China are prone to the risk of impaired health status and low utilization of public health services due to older age and unstable life.At present,there is a lack of research on incomerelated public health services utilization and health inequities in this population.Objective To understand the utilization of public health services and health status of elderly migrants,evaluate the utilization of public health services and health equities in them,and put forward suggestions for reducing income-related health inequalities.Methods In April 2022,elderly migrants aged 60 years or over(n=5840)were selected from the China Migrants Dynamic Survey 2018 as the study population.Public health service utilization was assessed using the data related to the use of health education,health records and family doctor services.Health status was assessed based on self-rated health and morbidity in the past one year.Socio-demographic,economic and migrant characteristics were collected as explanatory variables.The Erreygers-corrected concentration index(EI)was used to measure income-related inequality in the utilization of public health services and health status.The decomposition analysis based on logit model was used to quantify the contribution of each determinant to total inequality.Results Among the elderly migrants,the health education acceptance rate was 72.12%(4212/5840),with an EI of 0.021(P>0.05).The rate of health record establishment was 30.99%(1810/5840),with an EI of-0.054(P<0.05).And the rate of contracting a family doctor was 16.83%(983/5840),with an of EI of-0.057(P<0.05).Self-rated good health accounted for 82.29%(4806/5840),with an EI of 0.199(P<0.05).The morbidity rate in the past one year was 29.02%(1695/5840),with an EI of 0.123(P<0.05).The decomposition of EI results showed that per capita income had the highest percentage contribution to the equity of public health service utilization(74.354%,53.383%),followed by geographic range of migration(43.474%,32.063%).

关 键 词：流动老年人 健康公平 健康不平等 公共卫生服务 设施与服务利用 健康状况 健康社会决定因素 修正集中指数 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]