残疾人卫生服务利用及影响因素研究

Research on health service utilization of the disabled and influencing factors

目的了解我国残疾人的卫生服务利用水平及其影响因素,为相关政策制定和行动落实提供数据支持。方法建立持证残疾人登记、2018年残疾人动态监测以及第六次全国卫生服务统计调查等多元数据链接,并建立残疾人健康、卫生服务利用及其影响因素数据库,使用Stata 13.0软件开展定量分析。结果残疾人两周患病未治疗比例(3.9%)、两周就诊率(36.5%),均高于非残疾人(1.6%、32.2%)。残疾人就诊的影响因素logistic回归分析结果显示,以东部地区为对照,中部地区OR=0.73(95%CI:0.64~0.83);以男性为对照,女性OR=1.23(95%CI:1.11~1.37);以无医保者为对照,基本医保参保者OR=2.00(95%CI:1.23~3.26)。在控制了城乡、地区、年龄、医保、收入因素后,以无残疾者为对照,视力残疾人OR=1.28(95%CI:1.12~1.46)、躯体残疾人OR=1.31(95%CI:1.23~1.40)、精神残疾人OR=1.61(95%CI:1.37~1.90)。不同年龄组的住院率呈现“J”型分布,30~44岁组住院率最低(13.6%),60岁及以上组住院率最高(32.8%)。残疾人住院的影响因素logistic回归分析结果显示,以东部地区为对照,中部地区OR=1.48(95%CI:1.29~1.70)、西部地区OR=1.27(95%CI:1.11~1.46);以男性为对照,女性OR=1.23(95%CI:1.10~1.37);以文盲为对照,小学残疾人OR=1.32(95%CI:1.14~1.50)、初中残疾人OR=1.30(95%CI:1.10~1.53);以无医保者为对照,基本医保参保者OR=2.28(95%CI:1.31~3.98)。在控制了城乡、地区、年龄、医保、收入因素后,以无残疾者为对照,视力残疾人OR=1.39(95%CI:1.20~1.61)、躯体残疾人OR=1.63(95%CI:1.52~1.75)、精神残疾人OR=1.52(95%CI:1.27~1.83)。结论残疾人卫生服务利用水平较高,但是卫生服务不足问题依然存在,需对不同残疾类型的残疾人制定有针对性的政策。

Objective To understand the level of health service utilization of the disabled and its influencing factors,and provide information for relevant policy formulation and action implementation.Methods Multiple data links have been established for registered disabled persons,dynamic monitoring of disabled persons in 2018 and the Sixth National Statistical Survey on Health services,as well as a database on the health of disabled persons,utilization of health services and influencing factors,and Stata 13.0 was used for quantitative analysis.Results The proportion of the disabled who did not receive treatment within two weeks was 3.9%,and the rate of the disabled who received treatment within two weeks was 36.5%,both higher than those of non-disabled persons.The results of logistic regression analysis on the influencing factors of disabled people′s treatment showed that,taking the eastern region as the control,the OR of central region was 0.73(95%CI:0.64-0.83);taking males as the control,the OR of females was 1.23(95%CI:1.11-1.37);compared with those without medical insurance,OR of those with basic health insurance was 2.00(95%CI:1.23-3.26).After controlling urban and rural areas,regions,age,health insurance,and income,taking people without disabilities as the control,the OR of visual disabled was 1.28(95%CI:1.12-1.46),and the OR of physical disabled was 1.31(95%CI:1.23-1.40),the OR of mental disabled was 1.61(95%CI:1.37-1.90).The hospitalization rate of different age groups showed a"J-shaped"distribution.The hospitalization rate of the 30-44 years old was the lowest(13.6%),and the hospitalization rate of the above 60 years old was the highest(32.8%).The results of logistic regression analysis on the influencing factors of disabled people′s hospitalization showed that taking the eastern region as the control,the OR of central region was 1.48(95%CI:1.29-1.70),the OR of west region was 1.27(95%CI:1.11-1.46);taking males as control,the OR of females was 1.23(95%CI:1.10-1.53);taking illiteracy as the control,the OR of primary school was 1.32(95%CI:1.14-1.50),and the OR of junior high school was 1.30(95%CI:1.10-1.53);compared with those without health insurance,OR of those with basic health insurance was 2.28(95%CI:1.31-3.98).After controlling urban and rural areas,regions,age,health insurance,and income,taking people without disabilities as the control,the OR of visual disabled was 1.39(95%CI:1.20-1.61),and the OR of physical disabled was 1.63(95%CI:1.52-1.75),the OR of mentally disabled was 1.52(95%CI:1.27-1.83).Conclusion The level of health service utilization of disabled persons is high,but the problem of inadequate health service still exists.It is necessary to formulate targeted policies for persons with different types of disabilities.