家庭和社区健康环境对老年慢性病患者健康状况影响研究  

Impact of family and community health environment on the health status of elderly patients with chronic diseases

作　　者：靳思慧 郭胜鹏 王虎峰[1,2] JIN Si-hui;GUO Sheng-peng;WANG Hu-feng(School of Public Administration and Policy,Renmin University of China,Beijing 100872,China;Health Reform and Development Center of Renmin University of China,Health and Reform Policy Laboratory,Renmin University of China,Beijing 100872,China)

机构地区：[1]中国人民大学公共管理学院,北京100872 [2]中国人民大学医改研究中心健康与医改政策实验室,北京100872

出　　处：《中国卫生政策研究》2025年第3期41-47,共7页Chinese Journal of Health Policy

基　　金：国家社会科学基金重大项目(22ZDA096)。

摘　　要：目的:明晰家庭和社区健康环境在改善老年慢性病患者健康状况中的作用,为提升慢性病管理能力提供建议和参考。方法:基于2018年中国健康与养老追踪调查数据的9 388名老年慢性病患者,利用分层线性模型探究家庭和社区健康环境对老年慢性病患者健康状况的影响及其城乡和病种差异。结果:家庭健康环境能够改善老年慢性病患者自评健康(β=0.097,P<0.001)和控制结果(β=0.033,P<0.05),社区健康环境仅对自评健康有促进作用(β=0.062,P<0.001)。社区健康环境并未显著调节家庭健康环境与自评健康、控制结果之间的关系。家庭和社区健康环境对自评健康和控制结果的影响存在城乡差异,家庭健康环境对控制结果的影响存在病种差异。结论:家庭健康环境对老年慢性病患者健康状况的解释力高于社区健康环境,但二者尚未有效联动,建议融合老年慢性病患者健康需求以优化健康家庭建设,构建“患者—家庭—社区—基层医疗机构”四位一体慢性病综合治理体系,创新开拓慢性病管理新模式。Objective:This study aims to clarify the role of family and community health environments in improving the health status of elderly patients with chronic diseases,and provide recommendations and references for optimizing and enhancing chronic disease management capabilities.Methods:Based on data from the 2018 China Health and Retirement Longitudinal Study(CHARLS),this study analyzes a sample of 9,388 elderly patients with chronic diseases.A hierarchical linear model(HLM)is employed to examine the effects of family and community health environments on chronic disease management outcomes,as well as their variations across urban-rural settings and disease types.Results:The findings indicate that a supportive family health environment significantly improves both self-rated health(β=0.097,P<0.001)and disease control outcomes(β=0.033,P<0.05)among elderly patients with chronic diseases.In contrast,community health environments contribute positively only to self-rated health(β=0.062,P<0.001)but do not significantly affect disease control outcomes.Moreover,no moderating effect of community health environments was observed on the relationship between family health environments and either self-rated health or disease control.The effects of family and community health environment on self-rated health and control results were different between urban and rural areas,while the effects of family health environment on control results were different in disease types.Conclusion:The explanatory power of the family health environment on the health status of elderly patients with chronic diseases is higher than that of the community health environment.However,the two have not been effectively integrated.It is recommended to incorporate the health needs of elderly patients with chronic diseases into the optimization of healthy family construction and to establish a four-in-one comprehensive chronic disease management system involving“patients,families,communities,and primary healthcare institutions.”new models for chronic diseas

关 键 词：家庭健康 慢性病患者 健康生态学理论 分层线性模型 

分 类 号：R197[医药卫生—卫生事业管理]