中国中老年糖尿病患者卫生可及性现状及其影响因素研究

Access to healthcare and its determinants among Chinese diabetic patients

目的通过分析糖尿病患者卫生可及性的现状、影响因素及城乡差异,为城乡医疗资源配置、糖尿病管理及其教育项目提供政策建议。方法选取中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)2015年全国数据,采用有序多分类及二分类logistic回归分析糖尿患者卫生可及性的影响因素。结果多元回归结果显示:在控制了模型中其他因素后,城市糖尿病患者血糖检测次数(P<0.000 1)和个人护理知识知晓率(P=0.02)均高于农村患者;初中毕业和中专及以上学历的糖尿病患者血糖检测次数增加的几率为文盲患者的1.61和2.44倍,其差异具有统计学意义。结论中国糖尿病患者的卫生可及性亟待改善且存在明显的城乡差异。受教育程度是影响糖尿病患者卫生可及性的重要因素。政府应当积极在农村地区开展普及糖尿病管理的教育项目,并充分考虑人群的受教育水平及人口统计学因素。医疗卫生资源配置应当向农村地区倾斜。

Objective To provide policy suggestions concerning the distribution of health resources between urban and rural areas and management and education of diabetes, this study depicted the current status of access to healthcare and analyzed its determinants among Chinese diabetic patients. Methods Multivariate ordinal logistic regression and multivariate binary logistic regression were employed to analyze the effects of socioeconomic status and urban-rural disparities on health access. Results Multivariate results suggested that urban patients were more likely to conduct more blood glucose tests(P<0.000 1) and receive more self-care suggestions from physicians(P=0.02). After controlling all other covariates, patients graduated from secondary schools and those with vocational school degrees or above were 1.61 and 2.44 times more possible to take more blood glucose tests. Conclusions There exists significant urban-rural disparities of access to healthcare among Chinese diabetic patients. Education may be a key factor of access to healthcare among Chinese diabetic patients. It’s highly recommended to implement education programs on diabetes management in rural areas, where the education status and demographic factors should be considered. The distribution of health resource in rural areas requires more policy and governmental support.