基于Blinder-Oaxaca分解分析的中国城乡居民体检服务利用差异研究  

Study of urban-rural difference in health physical examination service utilization among residents(≥40 years old)in China on Blinder-Oaxaca decomposition analysis

作　　者：汤淑女[1] 尹香君[1] 崔丽嘉 崔露 李志新[3] 余卫[4] 夏维波[2] 王临虹[1] TANG Shunu;YIN Xiangjun;CUI Lijia;CUI Lu;LI Zhixin;YU Wei;XIA Weibo;WANG Linhong(National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China;不详)

机构地区：[1]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100050 [2]中国医学科学院北京协和医学院北京协和医院内分泌科,北京100730 [3]中国疾病预防控制中心妇幼保健中心 [4]中国医学科学院北京协和医学院北京协和医院放射科

出　　处：《中国慢性病预防与控制》2023年第6期433-437,443,共6页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：中央转移支付重大公共卫生项目[2018]8。

摘　　要：目的分析中国城乡≥40岁居民健康体检服务利用差异及成因,为促进健康体检服务利用和公平性提供依据。方法利用2018年首次中国居民骨质疏松症流行病学调查中≥40岁居民的健康体检服务相关数据,共纳入17152人。采用SAS 9.4软件进行Rao-Scott χ^(2)检验,采用基于复杂抽样的logistic回归系数假设检验进行趋势性检验分析。采用Stata 14.0软件Blinder-Oaxaca法定量分析不同因素对城乡差异的贡献程度。结果中国40岁及以上居民从未体检率为45.6%(95%CI:44.4%~46.7%),农村为53.1%(95%CI:51.5%~54.7%),高于城市的31.6%(95%CI:30.2%~33.1%),差异有统计学意义(P<0.01)。多因素logistic回归分析结果显示,农村(OR=1.608,95%CI:1.442~1.793)、小学及以下(OR=1.956,95%CI:1.605~2.384)、初中(OR=2.125,95%CI:1.783~2.533)、高中或中专或技校(OR=1.655,95%CI:1.424~1.923)、农林牧渔、服务业等(OR=1.539,95%CI:1.278~1.855)、未就业(OR=1.311,95%CI:1.065~1.613)、家庭人均年收入0~9999元(OR=2.819,95%CI:2.402~3.308)、10000~19999元(OR=2.530,95%CI:2.158~2.965)、20000~29999元(OR=1.758,95%CI:1.468~2.105)、无医疗保险(OR=1.964,95%CI:1.489~2.592)、无慢性病患病(OR=1.571,95%CI:1.400~1.764)、到离家最近的医疗机构时间≥30 min(OR=1.346,95%CI:1.149~1.577)人群从未体检的可能性高;年龄60~69岁(OR=0.572,95%CI:0.491~0.666)、70~79岁(OR=0.271,95%CI:0.219~0.337)、≥80岁(OR=0.371,95%CI:0.243~0.568)、女性(OR=0.784,95%CI:0.705~0.872)从未体检的可能性较低。在城乡从未体检的差异中,受教育程度和家庭人均年收入是解释差异的重要因素,受教育程度可以解释24.36%(P<0.01),家庭人均年收入可以解释18.85%(P<0.01)。结论中国城乡40岁及以上居民健康体检服务利用存在差异,城市优于农村,受教育程度和家庭人均年收入是解释城乡差异的重要因素。Objective To analyze urban-rural difference and cause in health physical examination service utilization among residents(≥40 years old)in China,and provide the basis for promoting the health physical examination service utilization and equality.Methods Based on the data of China Osteoporosis Epidemiological Survey in health physical examination service among residents(≥40 years old)of China in 2018,17152 residents were included.The used software was SAS 9.4,the Rao-Scott χ^(2)test was used to analyze the data,the complex sampling logistic regression coefficient hypothesis test was used for trend test analysis.Blinder-Oaxaca method was used to quantitatively analyze the contribution levels of different factors to urban-rural difference.Results The rate of no-physical examination among residents(≥40 years old)in China was 45.6%(95%CI:44.4%-46.7%).The rate(53.1%,95%CI:51.5%-54.7%)of no-physical examination in rural residents was significantly higher than that(31.6%,95%CI:30.2%-33.1%)in urban areas(P<0.01).The rate of no-physical examination among residents with rural areas(OR=1.608,95%CI:1.442-1.793),lower educational level(≤primary school,OR=1.956,95%CI:1.605-2.384;middle school,OR=2.125,95%CI:1.783-2.533;high school or technical school,OR=1.655,95%CI:1.424-1.923),job type(occupation in agriculture,forestry,husbandry,fishery,service industry,OR=1.539,95%CI:1.278-1.855,unemployed OR=1.311,95%CI:1.065-1.613),annual household income per capita(0-9999 yuan,OR=2.819,95%CI:2.402-3.308;10000-19999 yuan,OR=2.530,95%CI:2.158-2.965;20000-29999 yuan,OR=1.758,95%CI:1.468-2.105),no medical insurance(OR=1.964,95%CI:1.489-2.592),no chronic diseases(OR=1.571,95%CI:1.400-1.764),the time to the nearest medical institution≥30 min(OR=1.346,95%CI:1.149-1.577)were related to higher possibility of no physical examination;the higher age(60-69 years old group,OR=0.572,95%CI:0.491-0.666;70-79 years old group,OR=0.271,95%CI:0.219-0.337;≥80 years old group,OR=0.371,95%CI:0.243-0.568),and female(OR=0.784,95%CI:0.705-0.872)were rel

关 键 词：健康体检服务利用 城乡差异 成因 

分 类 号：R194[医药卫生—卫生事业管理]