社会分层视角下居家老年人预防保健服务利用研究

Studying on The Utilization of Preventive Health Care Services for The Housebound Elderly from The Perspective of Social Stratification

目的:社会分层视角下,探究山东省居家老年人预防保健服务的利用状况及影响因素。方法:采用多阶段分层随机抽样方法,于2018年4-9月抽取山东省某市居家老年人3200例进行问卷调查,采用描述性分析和二分类Logistic回归,分析其预防保健服务利用状况及主要影响因素。结果:(1)本研究中,社会下层和社会上层老年人分别占34.7%和65.3%。社会分层三个核心指标(职业地位、文化程度和收入水平)两两之间存在弱相关性。(2)本文主要利用的预防保健服务指标是一般健康检查(62.1%)、高血压筛查(49.4%)、查血项目(26.2%),不同社会分层居家老年人的预防保健服务利用状况有统计学差异(P<0.05)。社会分层为上层的居家老年人预防保健服务利用率(79.2%)高于社会下层老年人(62.6%)。(3)城乡、年龄、社会分层、医疗保险类型、健康自评、医疗机构离家的距离、是否患慢性病是影响居家老年人预防保健服务利用的主要因素(P<0.05)。城市、高年龄组、社会分层等级越高、享受公费医疗、城镇职工医疗的老年人,预防保健服务利用率越高。健康自评越好、患慢性病、医疗机构离家的距离越远,老年人预防保健服务利用率越低。结论:随着时代变迁,居家老年人的社会分层结构趋于弹性化。处于不同社会阶层的居家老年人,其卫生服务利用存在显著差异。针对影响居家老年人卫生保健服务利用的诸多因素,应提升基层医疗服务能力,强化慢性病防治,提高老年人主动就医的意识,进而提高卫生服务利用的公平性。

Objective To explore the utilization of preventive health care services in Shandong Province and its influencing factors from the perspective of social stratification.Methods 3200 elderly people were chosen from one city of Shandong with multi-stage stratified random sampling from April to September,2018,and surveyed with questionnaire.Data was analyzed with descriptive analysis and binary Logistic regression model.Results The proportion of the elderly in the lower and upper social classes was 34.7%and 65.3%,respectively.There had a weak correlation in pairs among the three core indicators of social stratification.There had significant difference of utilization of preventive health care services among the elderly living in different social strata(P<0.05).The utilization rate of preventive health care services in the upper class(79.2%)was higher than that in the lower classes(62.6%).The factors of areas,age,social stratification,medical insurance type,health self-assessment,distance of medical institutions from home,chronic diseases can influence the utilization of preventive health care services(P<0.05).Conclusion With the change of times,the social stratification structure of the elderly tends to be flexible.There are significant differences in the utilization of health services.It is suggested to improve the ability to primary medical services,strengthen the prevention and treatment of chronic diseases,and improve the awareness of the elderly to seek medical treatment actively,which can improve the fairness of health services.