中国大病发生及治疗的地理分析

The geographical analysis of the occurrence and treatment of severe diseases in China

罹患大病对患者及其家庭造成严重影响,治疗大病是基本的民生保障需求,因此大病问题是“健康中国”建设关注的一个重要对象。中国大病的发生和治疗均存在显著的空间分异性,采用地理学的视角和方法进行研究有助于改进各地的大病预防和全国的医疗资源配置。本文收集中国有代表性的大病互助平台公示的病例样本,以地级地区做为基本分析单元,采用空间相关性分析、地理探测器、多因素回归、地理不平等分解、出生世代分析等方法,得到如下研究结果:(1)肺癌、胃肠道癌、乳腺癌、脑卒中、急性心肌梗塞和甲状腺癌6种高发大病的空间聚集性均很强;(2)自然地理因素和人文地理因素对大病发生的解释力较强,但不同大病的影响因素有较大差异;(3)各地区的大病医疗资源差距较大,而患者在选择异地就医的目的地时,综合考虑了地理位置远近和医疗服务水平;(4)各地区大病“治疗发生比”在“胡焕庸线”两壁的差距很大;(5)全国大病“治疗发生比”的不平等程度正在随着更晚出生患者的增加而扩大,随着新医院的建立而缩小。最后,本文提出因地制宜地完善大病的预防、控制和治疗的政策建议。

Severe diseases have a significant impact on patients and their families,and treating severe diseases is a basic need for people's well-being,so the issue of severe diseases is one of the key focuses in constructing a Healthy China.The occurrence and treatment of severe diseases in China show significant spatial heterogeneity.Therefore,taking geographical perspectives and methods can improve efforts to prevent severe diseases in different regions and facilitate the allocation of healthcare resources nationwide.This article collected individual samples from a national representative severe disease mutual aid platform,using prefecture-level cities as the basic analysis unit.Spatial correlation analysis,geographical detector model,multiple variables regression,geographic inequality decomposition,and cohort analysis.This article found that:(1)strong spatial clustering phenomenon exists in six severe diseases,including lung cancer,gastrointestinal cancer,breast cancer,cerebral stroke,acute myocardial infarction-and thyroid cancer;(2)several natural geographic and human geographic factors have strong explanatory power for the occurrence of severe diseases,but large variations exist in influencing factors among different diseases;(3)significant differences exist in healthcare resources among regions,leading patients to weigh both geographical distance and the quality of medical services when choosing a destination for cross-border medical treatment;(4)the disparity in the treatment-to-occurrence ratio of severe diseases across regions is large between regions divided by the Hu Huanyong Line;(5)the inequality level of the national treatment-to-occurrence ratio increased with the evolution of newer birth cohorts among patients and decreased with the establishment of new hospitals.This article concludes by suggesting policy policies tailored to local conditions to improve the prevention,control,and treatment of severe diseases.