基于社会生态理论的老年人卫生服务可及性及其影响因素研究

Accessibility and Influencing Factors of Health Services among Older Adults based on Social Ecological Theory

目的了解我国老年人卫生服务可及性并分析其影响因素,为医疗资源的合理配置及老年人健康水平的提高提供科学参考。方法基于2014年中国老年健康影响因素跟踪调查数据(Chinese Longitudinal Healthy Longevity Survey,CLHLS),从地理可及性、可获得性、经济可及性三个方面对老年人卫生服务可及性进行评价,采用社会生态理论模型将影响因素分为个体特征、个人行为、人际层次、社区层次和政策层次,应用分层logistic回归模型分析影响可及性的因素。结果共纳入调查老年人7168例,不同地区间地理可及性差异有统计学意义(χ^(2)=451.8246,P<0.001),不同经济状况及时治疗率差异有统计学意义(χ^(2)=574.3525,P<0.001),城乡经济可及性差异有统计学意义(χ^(2)=6.7598,P<0.05)。社会生态理论模型中个体特征(性别、年龄、自评健康、文化程度)、个人行为(锻炼、睡眠质量)、人际层次(婚姻、居住方式、经济状况)、社区层次(居住地、上门看病送药)和政策层次(养老保障)对老年人卫生服务可及性解释较好。结论我国老年人卫生服务可及性受多层社会生态因素的影响,且表现出各个特征老年人之间可及性不均衡。需从老年人个体及其所处生态环境层面提高不同特征老年群体的卫生服务可及性,满足其卫生服务需求。

Objective This study aimed to investigate the current status of the accessibility of health service among Chinese older adults and analyze influencing factors to provide scientific reference for the rational allocation of medical resources and the improvement of the elderly′s health.Methods This study used a national representative sample from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)in 2014.The accessibility of health services for the old people is evaluated from three aspects of geographic accessibility,availability,and economic accessibility.Based on a social ecological theoretical model,the influencing factors are divided into individual characteristics,personal behavior,interpersonal level,community level and policy level,and we applied hierarchical logistic regression model to analyze the influencing factors of accessibility.Results A total of 7168 samples were used,and the proportions of geographic accessibility,availability,and economic accessibility were 34.11%,96.08%,and 67.86%.There are statistically significant differences in geographic accessibility between different regions(χ^(2)=451.8246,P<0.001),and timely treatment rates for different economic conditions are statistically different(χ^(2)=574.3525,P<0.001),the difference in economic accessibility between urban and rural areas is statistically significant(χ^(2)=6.7598,P<0.05).Based on the social ecological theory,individual characteristics(gender,age,self-assessment of health,education),personal behavior(exercising,sleeping),interpersonal level(marriage,living style,economic status),community level(place of residence,medical delivery services),and policy level(pension security)explain the accessibility of health services for the elderly better.Conclusion The accessibility of health services among Chinese older adults in China is affected by multiple layers of social and ecological factors,and shows the unbalanced accessibility with different characteristics.It is necessary to consider the individual and ecological environment so as to improve the accessibility of health services for elderly people with different characteristics,promote the fairness of health services and health levels,and meet the needs of their health services.