流动老年人健康状况的空间分布及与医疗卫生服务的关系研究

Study on the Spatial Distribution of Health Status of Floating Elderly and Its Relationship with Medical and Health Services

目的:分析流动老年人健康水平的空间差异,探索医疗卫生服务对流动老年人健康的影响作用,提出提升流动老年人健康水平的对策建议。方法:根据2017年国家卫生计生委全国流动人口动态监测项目的数据,收集31个省份中全部60岁及以上(即1957年4月及以前出生)的流动人口。使用SPSS 26.0软件进行单因素分析和二元logistic回归分析,探究医疗卫生服务对流动老年人健康的影响。使用Arcgis10.5软件绘制流动老年人健康水平分布地图及进行空间自相关分析。结果:(1)2017年流动老年人健康水平地区差异明显,东部高于中部和西部,表现出东高西低的现象。(2)流动老年人自评健康得分的Moran's I值为0.282(P<0.05),表明各地区流动老年人健康水平存在着空间正相关性。(3)Logistic回归分析显示,是否接受过免费随访评估或体检(OR=0.589,95%CI:0.500~0.694)对流动老年人健康状况具有显著影响。是否建立居民健康档案(OR=1.406,95%CI:1.254~1.576)、是否参加社会医疗保险(OR=1.387,95%CI:1.102~1.745)对流动老年人高血压或Ⅱ型糖尿病患病率具有显著影响。结论:(1)我国流动老年人健康水平地区差异明显,东部高于中部和西部。(2)自评健康得分聚集在中部和西部地区,均为低—低类型区。(3)我国流动老年人高血压或Ⅱ型糖尿病患病率地区差异明显,呈现“西—中—东”阶梯式递减的特点。(4)流动老年人自评健康得分的影响因素有性别、年龄、受教育程度(除研究生外)、婚姻状况、是否接受过免费随访评估或体检。(5)流动老年人高血压或Ⅱ型糖尿病患病率的影响因素有性别、年龄、是否建立居民健康档案、是否参加社会医疗保险。

Objective To analyze the spatial distribution differences of the health level of the floating elderly,explore the impact of medical and health services on the health of the floating elderly,and put forward countermeasures and suggestions to improve the health level of the floating elderly.Methods According to data from the 2017 National Floating Population Dynamic Monitoring Project of the National Health and Family Planning Commission,all the floating population aged 60 and over in 31 provinces were collected.SPSS 26.0 software was used for univariate analysis and binary logistic regression analysis to explore the impact of medical and health services on the health of the floating elderly.The Arcgis10.5 software was used to map the health level distribution of the floating elderly and conduct spatial autocorrelation analysis.Results In 2017,the health level of the floating elderly was significantly regional difference,in which the eastern region was higher than the central and western regions,showing a phenomenon of higher health level in the east and lower health level in the west.The Moran's I value of the self-rated health score of the floating elderly was 0.282(P<0.05),indicating that there was a spatial positive correlation in the health level of the floating elderly in different regions.Logistic regression analysis showed that whether having received free follow-up evaluation or physical examination(OR=0.589,95%CI:0.500-0.694)had a significant impact on the health status of the floating elderly.Whether to establish health records(OR=1.406,95%CI:1.254-1.576)and whether to participate in social medical insurance(OR=1.387,95%CI:1.102-1.745)had a significant impact on the prevalence of hypertension or type 2 diabetes in the floating elderly.Conclusion The health level of the floating elderly in China has obviously regional differences,in which the eastern part is higher than the central and western part.The self-rated health scores were clustered in the central and western regions,all of which were low-low type areas.The prevalence rate of hypertension or type II diabetes among the floating elderly in China is significantly regional different,showing the characteristics of"west-center-east"step decline.The factors influencing the self-rated health scores of the floating elderly are gender,age,education level(except graduate students),marital status,and whether having received free follow-up evaluation or physical examination.The influencing factors of the prevalence of hypertension or type II diabetes among the floating elderly include gender,age,whether to establish resident health records,and whether to participate in social medical insurance.