农村老年人医疗保险参与和自杀风险的关系

Relationship between medical insurance participation and risk of suicide among rural elderly

目的探讨农村老年人医疗保险参与行为与自杀风险的关系。方法采用“2010年中国城乡老年人口状况追踪调查数据”。该调查以年满60周岁及以上老年人为调查对象,采用与规模呈正比的分层随机抽样方法,对20个省、自治区、直辖市展开调查。研究采用的农村地区老年人有效样本为7873人。问卷中包含了基本人口统计学信息、医疗保险和自杀风险等相关问题。采用二分类Logistic回归模型进行分析。结果农村老年人自杀风险报告率为6.03%,并在不同参保行为的群体中具有显著差异(χ^(2)=9.42,P=0.002)。二分类Logistic回归模型分析显示,与自杀风险相关的因素有医疗保险(OR=0.513,95%CI=0.285~0.922)、文化程度(小学:OR=0.718,95%CI=0.573~0.898;初中及以上:OR=0.670,95%CI=0.453~0.989)、是否负债(OR=1.557,95%CI=1.236~1.962)、经济保障(OR=0.719,95%CI=0.574~0.900)、身体状况(较差:OR=0.768,95%CI=0.572~1.031;一般:OR=0.307,95%CI=0.224~0.420;较好:OR=0.316,95%CI=0.206~0.486;很好:OR=0.175,95%CI=0.061~0.494)、有无慢性病(OR=1.970,95%CI=1.448~2.681)、心理负担(OR=1.027,95%CI=1.015~1.039)、家庭关系(OR=0.350,95%CI=0.253~0.484)等。结论医疗保险参与行为与自杀风险显著相关。提高医疗保险在农村地区的覆盖率和保障水平,探索和完善农村大病救助体系,有助于改善农村老年人精神健康状况,降低自杀行为的发生风险。

Objective To investigate the relationship between medical insurance participation and risk of suicide among rural elderly.Methods The“2010 China Urban and Rural Elderly Population Tracking Survey Data”were mined.Using a stratified random sampling method of proportional to the scale,elderly aged 60 years and above were surveyed in 20 provinces,autonomous regions,and municipalities.Altogether 7873 subjects were enrolled,who were surveyed with a questionnaire composed of basic demographic information,medical insurance participation,suicidal behaviors and other related questions.Data collected were analyzed with a binary Logistic regression model.Results The reported risk of suicide among rural elderly was 6.03%,and there was significant differences among groups with different insurance participations(χ^(2)=9.42,P=0.002).The binary Logistic regression model showed that factors related to risk of suicide included health insurance(OR=0.513,95%CI=0.285-0.922),education level(elementary school:OR=0.718,95%CI=0.573-0.898;junior high school and above:OR=0.670,95%CI=0.453-0.989),debt status(OR=1.557,95%CI=1.236-1.962),financial security(OR=0.719,95%CI=0.574-0.900),health status(poor:OR=0.768,95%CI=0.572-1.031;fair:OR=0.307,95%CI=0.224-0.420;good:OR=0.316,95%CI=0.206-0.486;very good:OR=0.175,95%CI=0.061-0.494),chronic diseases(OR=1.970,95%CI=1.448-2.681),psychological burden(OR=1.027,95%CI=1.015-1.039),family relationship(OR=0.350,95%CI=0.253-0.484),and so on.Conclusion Medical insurance participation is significantly related to the risk of suicide.Enhancing the coverage rate and insurance level and improving the rural serious diseases relief system will help improve the mental health of rural elderly and reduce the risk of suicide.