邯郸眼病研究中新型农村合作医疗改革下邯郸农村地区眼卫生服务利用的变化

Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme： the Handan Eye Study

目的 评估2009年新型农村合作医疗改革后邯郸农村地区的眼卫生服务利用率及其影响因素.方法 以人口为基础的纵向队列研究.对参与邯郸眼病研究2006至2007年基线调研且2012年至2013年被随访到的研究对象进行流行病学调查,收集研究对象的资料,包括人口学资料、病史资料、新型农村合作医疗参与情况、眼卫生服务利用情况问卷、全面眼科检查、全身状况检查,分析多种变量对眼病的影响.两均数间的比较用Wilcoxon秩和检验;离散型变量的显著性采用卡方检验;建立多变量二元Logistics回归模型.结果 5年随访合格者5193人,其中男性2304人,女性2889人,年龄（57±11）岁.其中549人[10.6％,95％可信区间（CI）为9.8％～11.4％]有过眼卫生服务经历,较基线无明显变化（χ2=1.64,P=0.200）.50.1％（291人次）的眼卫生服务由市级医院承担＂.没必要＂（4422人,占95.2％）为受访者不看眼病的首要原因,其中有眼科疾病者2874人（65.0％）,有眼不适主诉者3505人（79.3％）,较基线比例增加（χ2=5.97,9.38;P〈0.05）.在多变量二元Logistics模型中,有相对较高眼卫生服务趋势包括年长[P〈0.001,矫正比值比（OR）为1.32,95％CI为1.18～1.48]、女性（P=0.013,OR为1.47,95％CI为1.09～1.98）、收入低（P=0.041,OR为0.83,95％CI为0.69～0.92）、有糖尿病史（P=0.022,OR为1.39,95％CI为1.05～1.84）、主诉有眼部症状（P〈0.001,OR为3.56,95％CI为2.48～5.09）、屈光不正（P=0.043,OR为1.26,95％CI为1.01～1.57）、视力损伤（P〈0.001,OR为4.40,95％CI为2.67～7.25）和患白内障（P=0.039,OR为1.28,95％CI为1.01～1.61）.结论 新型农村合作医疗改革之后,虽然邯郸农村地区新型农村合作医疗覆盖率大幅增加,但是当地眼卫生服务利用率仍处于较低水平.继续提高乡镇卫生院和村卫生室的医疗水平,推广农村地区眼健康教育,可能有助于农村地区眼卫生服务利用率的提高.

Objective To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods In a cohort population-based study, subjects who joined both the baseline （2006-2007） and follow-up （2012-2013） were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval （CO, 9.8%- 11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys （P=0.20）. The municipal hospitals undertook 50.1% of eye care services. ＂No need＂ （4 422, 95.2%） was the most common reason cited for not using an eye care service; 2 875 （65.0%） of these participants had at least one type of eye diseases, 3 505 （79.3%） had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio （OR）, 1.319; 95%CI, 1.177-1.478], were female （adjusted OR, 1.466; 95%CI, 1.085-1.981）, had a diabetes history （adjusted OR, 1.930; 95%C1, 1.381-2.696）, had a low income （adjusted OR, 0.826; 95%CI, 0.688-0.922）, had ocular complaints （adjusted OR, 3.556; 95%C1, 2.484-5.091）, had refractive errors （adjusted OR, 1.256; 95%CI, 1.007-1.567）, had visual impairment （adjusted OR, 4.398; 95%CI, 2.667-7.253） or had cataract （adjusted OR, 1.278; 95%CI, 1.013-1.612） were more likely to take an eye care service. Conehlsions Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village climes as well as better education about eye disease among the rural population may raise the eye care use in rural areas.