肥胖的全球聚集性分布及卫生经费影响的中介效应分析

Analysis on the Global Aggregation Distribution of Obesity and the Mesomeric Effect of Health Expenditure

目的:了解肥胖的全球分布特点及卫生经费供给对肥胖最终发生的中介效应。方法:数据来源于《2022中国卫生健康统计年鉴》,各国边界使用国家基础地理信息中心shp格式的地图数据。采用SaTScan 10.1软件的Poisson模型进行空间聚集性扫描,采用ArcGIS 10.8对聚集性扫描结果进行可视化分析;采用AMOS 22.0软件进行中介效应分析,用Bootstrap方法进行中介效应的检验,检验标准α=0.05。结果:肥胖率较高的国家大多位于南美洲、北美洲、欧洲和大洋洲,肥胖率较低的国家大多位于非洲和亚洲。卫生经费影响肥胖发生的总效应(即直接效应+中介效应)有统计学意义(Z=3.551,P<0.01)、直接效应无统计学意义(Z=0.386,P=0.699),即卫生经费供给对肥胖的影响属于完全中介效应,卫生经费供给必须通过卫生覆盖情况影响儿童健康危害后再影响肥胖的最终发生。结论:肥胖主要发生在社会经济较发达的地区,儿童健康危害对肥胖的发生有决定性的影响。

OBJECTIVE To Understand the global distribution characteristics of obesity and the mediating effect of health fund⁃ing supply on the ultimate occurrence of obesity.METHODS The data was sourced from THE 2022 CHINA HEALTH STATISTICAL YEARBOOK by the National Health Commission,and map data in the SHP format of the National Basic Geographic Information Cen⁃ter was used for the borders of various countries.Using the Poisson model of SaTScan10.1 for spatial clustering scanning,and visual⁃izing the clustering scanning results using ArcGIS10.8.Using Amos 22.0 for mediating effect analysis and Bootstrap method for medi⁃ating effect testing,α=0.05.RESULTS The countries with higher obesity rates are mostly located in North and South America Eu⁃rope,and Oceania,while the countries with lower obesity rates are mostly located in Africa and Asia.The total effect of health fund⁃ing on the occurrence of obesity(direct effect+mediating effect)was statistically significant(Z=3.551,P<0.01),while the direct ef⁃fect is not statistically significant(Z=0.386,P=0.699).There was a complete mediating effect between the supply of health funding and the ultimate occurrence of obesity.The supply of health funding must influence the health hazards of children through health coverage before affecting the ultimate occurrence of obesity.CONCLUSION Obesity mainly occurs in economically developed re⁃gions,and the health hazards of children have a decisive impact on the occurrence of obesity.