中国农村居民健康影响因素分析

Self-rated health and its influencing factors among adult rural residents in China

目的分析中国农村居民自评健康状况及影响因素,为提高中国农村居民健康水平提供参考依据。方法于2011年1月—2012年4月应用多阶段随机抽样、概率与规模成比例抽样方法在河南、河北、山东、黑龙江、江苏、海南、宁夏省和北京市抽取10 161名年龄≥18岁农村居民进行入户调查,采用Kruskal-Wallis秩和检验、Spearman等级相关检验、多分类有序logistic回归对数据进行统计分析。结果 10 161名年龄≥18岁农村居民中,男性4 116人(40.51%),女性6 045人(59.49%);平均年龄47.08岁;学历中小学及以下4 654人(45.81%),初中4 249人(41.82%),高中及以上1 258人(12.37%);务农7 594人(74.74%),其他职业2 567人(25.26%);71.47%(7 262/10 161)的农村居民自评健康状况非常好/较好,仍有28.53%(2 899/10 161)的居民对自身健康状况不十分满意;多因素分析显示,农村居民随着年龄增大自评健康水平逐渐下降(P<0.01);随着受教育水平升高自评健康水平升高(P<0.01);农民、打工者和个体工商业者的健康水平明显低于固定工作者(P<0.05);河北、海南、宁夏、北京的农村居民健康水平低于河南省,而山东、黑龙江、江苏相对较高(P<0.05);患有慢病者较无慢病者自评健康水平高(P<0.01);无医疗保险者健康水平高于有医疗保险者(P<0.01);贫困户健康水平低于普通人群(P<0.01);自评经济地位越高,自评健康水平越高(P<0.01);越容易向周围人借到5 000元钱者自评健康水平越高(P<0.01);随着家庭医疗支出的升高,自评健康水平下降(P<0.01)。结论中国农村居民自评健康与年龄和家庭医疗支出水平负相关,与受教育水平、社会经济地位和向周围人借款5 000元的难易程度正相关,患慢病人群、贫困户、有医疗保险者、农民、打工者和个体工商业者的自评健康水平较低,地区间自评健康水平也存在差异。

Objective To analyze self-rated health and its influencing factors among rural residents in China and to provide a scientific basis for improving health status of Chinese rural population. Methods A household questionnaire interviewwas conducted among 10 161 rural residents aged 18 years and above selected with multistage random sampling and probability proportional to size sampling from 48 villages of 15 counties in 6 provinces,one autonomous region and one municipality from January 2011 through April 2012. Kruskal-Wallis rank test,Spearman rank correlation and ordered logistic multivariate regression were used to analyze the data collected on self-rated health and its related factors. Results Of the residents surveyed,4 116（ 40. 51%） were male and 6 045（ 59. 49%） were female,with an average age of 47. 08years; 4 654（ 45. 81%）,4 249（ 41. 82%）,and 1 258（ 12. 37%） had the education of primary school or below,middle school,and high school or above; 7 594（ 74. 74%） were engaged in agriculture work and 2 567（ 25. 26%） in other occupations. Among the residents,71. 47%（ 7 262） reported very good / good health status,while 28. 53%（ 2 899） considered their health status being not good enough. The results of ordered logistic multivariate regression demonstrated that selfrated health level declined with the increment of age and familial medical expenditure（ both P〈0. 01）,but increased with education level and self-reported familial economic condition（ both P〈0. 01）; the residents with stable employment reported a significantly higher health status than the residents being farmer,temporary worker,and individual industrialist or businessman（ P〈0. 05）; the residents in Henan province reported a higher health status than those in Hebei province,Hainan province,Ningxia Hui Autonomous Region,and Beijing municipality but a lower health status than those in Shandong,Heilongjiang,and Jiangsu province（ P〈0. 05 for all）; compared to those with chronic diseases and lowfamilial economic condition,the residents with medical security and general familial economic condition had a better self-rated health（ both P〈0. 01）; the residents with the perspective of being easy to borrow5 000 yuan RM B from their neighbors reported a better health than those without the perspective（ P〈0. 01）. Conclusion Self-rated health is negatively related to age and familial medical expenditure and positively to education,social economic condition,and the easiness to borrow5 000 yuan RM B from neighbors,and there is a regional difference in self-rated health among rural adult residents in China; the residents with chronic diseases,poor familial economic condition,medical insurance and being a farmer,temporary worker or individual industrialist or businessman have a lower self-rated health.