生活水平指标选择对健康及卫生服务利用公平性指数的影响

目的:研究不同生活水平指标下的健康及卫生服务利用公平性指数测算结果及其差异。方法:采取多阶段分层随机抽样抽取宁夏地区农村家庭,收集家庭收入、消费和财富以及居民健康、卫生服务利用等相关数据,采用集中指数方法,分别以收入、消费和财富指数做为生活水平指标,测量样本人群健康和卫生服务利用公平性,并对其差异进行分析。结果:选用不同生活水平指标得到的结果相关性较弱,其测得的集中指数间差异在0.01~0.21之间,大部分在0.05水平上显著。结论:选用不同生活水平指标对健康及卫生服务利用公平性指数测算具有显著影响;在一定区域内对生活水平进行测量,财富指数能够获得比收入和消费更为客观和真实的结果,但其使用条件更为严格。     

农村家庭生活水平检测及围产期保健与财富指标的关系分析

目的探索在农村进行家庭调查时测量家庭生活水平的合适方法,并衡量不同家庭生活水平与围产期保健相关指标的关系。方法数据来源于卫生部与联合国儿童基金会资助的项目《中国西部农村新生儿低出生体重的微营养素干预研究》。用财富指数法对调查家庭的生活水平分类,比较不同家庭生活水平围产期保健相关指标的差异。结果主成分分析法构造的财富指数与家庭收入和支出调查一致性较好。贫困家庭的孕前贫血率、早产率、死胎死产率和围产儿死亡率均显著高于富裕家庭,对免费产后访视的利用也显著高于富裕家庭。结论主成分分析法构造的财富指数适合于衡量农村地区家庭生活水平。且围产期的贫血、死亡等与家庭生活水平显著相关。     

农村家庭生活水平与产前检查的关系研究--基于不同的家庭生活水平测量方法

目的：比较对家庭生活水平的不同测量方法间的相关性,在此基础上,进一步研究家庭生活水平与产前检查相关指标的关系。方法数据来源于本课题组在2010年所完成的《陕西省农村围产期保健状况调查》项目。对4719名孕妇家庭的资料分别用主成分分析法和潜在类别模型构造的财富指数及自感经济对家庭生活水平进行分类,比较不同家庭生活水平群体间产前检查相关指标的差异。不同测量方法下的家庭生活水平预测产前检查相关指标的能力比较采用受试者操作特征曲线（ ROC）和多因素Logistic回归分析。结果主成分分析法和潜在类别模型构造的财富指数表现了较好的相关性和一致性,而与自感经济呈负相关（Spearman值分别为－0．175和－0．111,相应的P值分别为＜0．001和＜0．003）;以前两种方法对家庭生活水平进行分类,富裕家庭的产前检查相关指标均显著高于贫困家庭（以主成分法分类的家庭经济指标－产前检查次数≥5次、首次产前检查＜12孕周、完成推荐产检内容和产检地点在乡及以上医院的比例有差异的χ2值分别为21．8、20．5、13．1和13．7;以潜在类别法分类的家庭经济指标－产前检查次数≥5次、首次产前检查＜12孕周、完成推荐产检内容和产检地点在乡及以上医院的比例有差异的χ2值分别为64．2、35．1、17．6和20．7,均P＜0．001）。以潜在类别模型构造的财富指数分类的家庭生活水平对产前检查相关指标的ROC曲线下面积大于主成分分析法,但差异不具有统计学意义（ P＞0．05）;对产前检查相关指标的多因素Logistic回归分析的预测概率略大于主成分分析法。结论用潜在类别模型和主成分分析法构造的财富指数衡量的农村地区家庭生活水平,均适用于研究其与产前检查的关系,且潜在类别模型法更具优势。     

以财富指数观察居民卫生服务利用研究

目的:构建财富指数,用财富指数衡量家庭经济水平,分析不同经济水平居民卫生服务利用现状以及存在的问题。方法:采用多阶段分层随机整群抽样方法抽取农村和城镇样本家庭,收集样本家庭财产、收入和支出情况以及家庭成员卫生服务需要、需求和利用的相关数据,采用因子分析方法构建家庭财富指数。结果:城镇家庭财富指数与家庭年收入、家庭年支出的相关系数分别是0.538、0.511。农村家庭财富指数与农村家庭年收入、家庭年支出的相关系数分别为0.596、0.483。经济状况不佳影响居民门诊和住院服务利用。结论:以家庭耐用消费品作为家庭财产构建财富指数代表家庭的经济水平其稳定性更强,数据也更容易收集。通过提高收入、完善基本医疗保障制度、发展基层医疗机构等多项措施,改善和提高低收入居民卫生服务利用状况。     

家庭经济状况评价指标探讨

从家庭消费的角度探讨了可用于评价家庭经济状况的指标，以家庭耐用消费品的拥有量为基础，采用中位数定权的方法，得到每个家庭耐用消费品的得分并以此分类，然后用家庭人均年收入水平作参考对分类进行调整，最后得到家庭经济状况的分类水平。通过用该方法对１９８９及１９９１年＂中国经济、人口和营养健康状况＂调查中的居民经济状况分类发现，结果比较接近实际。     

游程总数法与传统方法诊断发表偏倚的一致性

摘要:目的　评价基于发表时间顺序构建的游程总数法与基于效应量及其误差项构建的传统方法诊断发表偏倚的一致性。方法　产生Meta分析模拟数据采用Kappa指数评价诊断方法的一致性。结果　对于有偏和无偏Meta分析模拟数据两类方法诊断发表偏倚的一致性Kappa指数处于0～0.4之间。结论　依不同理论依据构建的发表偏倚诊断方法的诊断一致性差,为探讨构建两类诊断方法间的联合诊断发表偏倚的方案提供了参考依据。     

灾难性卫生支出发生情况比较分析：基于社区卫生综合改革典型城市居民健康询问调查

目的：比较8个社区卫生综合改革典型城市居民家庭灾难性卫生支出发生情况、分析卫生筹资及人均可支配收入对灾难性卫生支出的影响。方法：采用集中指数比较不同经济水平家庭灾难性卫生支出的分布。结果：城市居民人均可支配收入与灾难性卫生支出发生率及平均差距呈负相关;杭州和合肥集中指数为负值,武汉、成都、无锡、宝鸡和石河子集中指数为正值。结论：贫困家庭通过减少医疗花费避免灾难性的经济支出;采取多种方法提高经济水平和居民家庭经济收入,减少灾难性卫生支出,维护公平性。     

综合医院综合效益评价的病例组合模型研究

目的建立一种考虑病人病例组合的医院综合效益评价模型,以控制传统评价模型中各医院救治病人疾病复杂程度不同所致的偏倚。方法各医院病人疾病复杂程度由根据信息理论计算的病例组合指数(CMI)进行测量。采用病例组合指数对综合效益传统评价模型中指标进行调整(标化)得到新的病例组合评价模型。分别采用传统评价模型与病例组合评价模型评价2003年南充地区9所综合医院综合效益,比较两种模型得到的各医院综合效益排序情况。评价主要步骤包括从投入和产出角度构建评价指标体系,采用层次分析法确定各评价指标权重,根据投入产出比构建综合评价指数。结果9所医院的CMI值不同,其中有6所医院的CMI<1,3所医院的CMI值>1。9所医院中有7所医院采用病例组合模型得到的综合效益位次与采用传统评价模型得到的一致,另2所医院采用病例组合模型得到的位次与传统评价模型得到的位次不同。结论相对于传统评价模型,病例组合评价模型考虑了医院病人疾病复杂程度的影响,得出的结论更为客观真实。     

过程能力指数应用于临床测量一致性评价的探讨

目的探讨将过程能力指数应用于临床测量一致性评价的可行性和必要性。方法采用某多中心研究评价引导穿刺仪穿刺效果的临床试验数据,采用现有的临床评价手段和过程能力指数分别评价实际操作结果与预计值之间的一致性。结果两个研究中心的临床评价均达到满意的临床应用评价标准,在过程能力指数分析中两中心的测量结果存在一定差别。结论应用过程能力指数进行临床测量一致性评价可以定量描述测量差值的特征为现有临床评价方法提供有益的补充。     

病例组合指数法在医院住院成本分析中的应用

目的：探讨住院病人成本的影响因素，并对其进行定量测量。方法：近照国际疾病ICD－9分类编码，采用病例组合指数法医院产出组成进行测量；彩和STAT，SPSS软件用最小二乘法，龄回归方法分别建立人均住院成本的回归模型并进行比较；对人均住院成本影响因素做相关分析；采用岭回归方法建立了引入病例组合指数等6个变量的人均住院成本的多元回归计量模型，结果：由于引入病例组合指数，考虑到了医院产出组成对人均住院成本的影响，使该成本分析更趋于合理；采用岭回归方法建立的回归模型相对于最小二乘法建立的回归模型而言，改善了自变量间多元共线性的效应，降低了回归系数的标准误，回归模型结果更稳定。结果：定量地测量了病例组合指数因素对人均住院成本的影响。     

Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries

Background

Epidemiological studies often require measures of socio-economic position (SEP). The application of principal components analysis (PCA) to data on asset-ownership is one popular approach to household SEP measurement. Proponents suggest that the approach provides a rational fmethod for weighting asset data in a single indicator, captures the most important aspect of SEP for health studies, and is based on data that are readily available and/or simple to collect. However, the use of PCA on asset data may not be the best approach to SEP measurement. There remains concern that this approach can obscure the meaning of the final index and is statistically inappropriate for use with discrete data. In addition, the choice of assets to include and the level of agreement between wealth indices and more conventional measures of SEP such as consumption expenditure remain unclear. We discuss these issues, illustrating our examples with data from the Malawi Integrated Household Survey 2004–5.

Methods

Wealth indices were constructed using the assets on which data are collected within Demographic and Health Surveys. Indices were constructed using five weighting methods: PCA, PCA using dichotomised versions of categorical variables, equal weights, weights equal to the inverse of the proportion of households owning the item, and Multiple Correspondence Analysis. Agreement between indices was assessed. Indices were compared with per capita consumption expenditure, and the difference in agreement assessed when different methods were used to adjust consumption expenditure for household size and composition.

Results

All indices demonstrated similarly modest agreement with consumption expenditure. The indices constructed using dichotomised data showed strong agreement with each other, as did the indices constructed using categorical data. Agreement was lower between indices using data coded in different ways. The level of agreement between wealth indices and consumption expenditure did not differ when different consumption equivalence scales were applied.

Conclusion

This study questions the appropriateness of wealth indices as proxies for consumption expenditure. The choice of data included had a greater influence on the wealth index than the method used to weight the data. Despite the limitations of PCA, alternative methods also all had disadvantages.     

Population-based health indexes: a systematic review

This paper presents a systematic review the literature pertaining to the development and use of population-based health indexes with regard to reason for development of the index, geographical level of aggregation, inclusion of health indicators, weighting, sources of data and validation. Any type of population-based health index that incorporated at least two health indicators was considered for inclusion in the review. Studies from the UK, Europe and North America were considered. Seventeen individual studies and one review describing a population-based health index are described. The health indexes were designed for a wide variety of purposes. Levels of geographical aggregation ranged from ward to national level. There was considerable variation between these studies regarding the indicators chosen for inclusion in the health indexes as well as the methods used to combine them. Fourteen of the 18 included studies reported information on weighting of the indicators. None of the studies gave justification for the method of weighting chosen. Indicators were on the whole obtained from routine data sources. Only four of the indexes addressed the problem of validity. A population-based health index is potentially a very useful tool for monitoring the health of a community. More research is needed to determine which health indicators should be used in the formation of such an index and the most appropriate method to combine them.     

Estimating the absolute wealth of households

ObjectiveTo estimate the absolute wealth of households using data from demographic and health surveys.MethodsWe developed a new metric, the absolute wealth estimate, based on the rank of each surveyed household according to its material assets and the assumed shape of the distribution of wealth among surveyed households. Using data from 156 demographic and health surveys in 66 countries, we calculated absolute wealth estimates for households. We validated the method by comparing the proportion of households defined as poor using our estimates with published World Bank poverty headcounts. We also compared the accuracy of absolute versus relative wealth estimates for the prediction of anthropometric measures.FindingsThe median absolute wealth estimates of 1 403 186 households were 2056 international dollars per capita (interquartile range: 723–6103). The proportion of poor households based on absolute wealth estimates were strongly correlated with World Bank estimates of populations living on less than 2.00 United States dollars per capita per day (R² = 0.84). Absolute wealth estimates were better predictors of anthropometric measures than relative wealth indexes.ConclusionAbsolute wealth estimates provide new opportunities for comparative research to assess the effects of economic resources on health and human capital, as well as the long-term health consequences of economic change and inequality.     

伤寒Vi疫苗效果观察对象社会经济与行为学的研究

目的掌握疫苗观察对象的生活水平、消费行为、居住环境等社会经济活动情况,为正确评价疫苗效果提供科学依据。方法采用国际疫苗研究所统一制订的调查表,上门逐户调查研究人群39050户共135737人,用统计学方法分析观察人群的生活水平、消费行为、居住环境等社会经济活动的差异性。结果在当地居住5年以上的户口占82．4％;家庭主要职业,城市以上班族为多,占35．2％,农村以农民为主,占56．9％;家庭每月平均收入城市为1338元、农村为794元。城市家庭每月平均支出为896元、农村为481元,其中食品支出占总收入的43％,其次为房租;住房情况城市优于农村,城市有80％的家庭拥有3间以上住房,而农村只有50％;城市家庭拥有私人住房的占74．4％,农村占69．5％;城市主要以私人汽车及摩托车作为交通工具,而农村则为自行车;城市家庭以电视机、沙发、电冰箱、自行车为四大件,电视机、自行车为农村的两大件。结论疫苗观察人群的平均生活水平远远低于全国平均生活水平,属于思格尔系数划分的低层次小康标准。对于科学实施疫苗效果的观察来说,仍不失为一个条件适宜,生活水平、消费行为、生活环境相对平衡的自然群体,上述调查内容也是一项科学研究必不可少的本底调查。     

The relationship between parity and overweight varies with household wealth and national development

BACKGROUND: Recent studies support a positive relationship between parity and overweight among women of developing countries; however, it is unclear whether these effects vary by household wealth and national development. Our objective was to determine whether the association between parity and overweight [body mass index (BMI) > or =25 kg/m(2)] in women living in developing countries varies with levels of national human development and/or household wealth. METHODS: We used data from 28 nationally representative, cross-sectional surveys conducted between 1996 and 2003 (n = 275 704 women, 15-49 years). The relationship between parity and overweight was modelled using logistic regression, controlling for several biological and sociodemographic factors and national development, as reflected by the United Nations' Human Development Index. We also modelled the interaction between parity and national development, and the three-way interaction between parity, household wealth and national development. RESULTS: Parity had a weak, positive association with overweight, which varied by household wealth and national development. Among the poorest women and women in the second tertile of household wealth, parity was positively related to overweight only in the most developed countries. Among the wealthiest women, parity was positively related to overweight regardless of the level of national development. CONCLUSIONS: As development increases, the burden of parity-related overweight shifts to include poor as well as wealthy women. In the least-developed countries, programmes to prevent parity-related overweight should target wealthy women, whereas such programmes should be provided to all women in more developed countries.     

A composite index to explain variations in poverty, health, nutritional status and standard of living: use of multivariate statistical methods

OBJECTIVES: To calculate the Human Development Index (HDI) and Human Poverty Index (HPI) of Indian states; to trace the indicators useful for finding variations in poverty; and to develop a composite index that may explain variations in poverty, health, nutritional status and standard of living. STUDY DESIGN: Cross-sectional study. METHODS: The HDI and HPI were calculated for different Indian states. A set of possible indicators varying between rich and poor states of India was identified with the use of discriminant function analysis. A composite index has been developed for measuring the standard of living of Indian states with the help of factor analysis. RESULTS: Demographic, socio-economic, health and dietary indicators play a major role in determining the real standard of living. Poverty, standard of living and human development depend on multiple factors. The existing indices, such as HDI and HPI, use income indicators to measure the standard of living, and do not take into account diet and nutritional status indicators. The proposed index was found to be more suitable for measuring the real standard of living and human development, as it is a comprehensive index of income and non-income indicators. Further validation may be carried out for different populations. CONCLUSIONS: Discriminant function analysis and factor analysis were used to assess health inequality and standard of living among Indian states. The proposed multi-dimensional index may provide a better picture of human development. Further work is of interest for other populations.     

Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: socioeconomic environment and childhood overweight

Objective

The objective of this study is to evaluate whether the relation between area-based socioeconomic environment and childhood obesity can be explained by household socioeconomic position, obesity-related risk behaviours and area facilities.

Methods

Two indicators of socioeconomic environment based on wealth and deprivation were estimated in a sample of 4529 Spanish children and adolescents in 2006. Multilevel logit models were used to calculate the relation between each indicator and obesity.

Results

After adjusting for socioeconomic position and risk behaviours, no relation was observed between wealth and overweight; however, obesity prevalence was 1.45 times higher in subjects living in areas with lower wealth than in those living in areas with higher wealth. After adjusting for these variables, the prevalence of overweight and obesity in subjects living in deprived areas was, respectively, 1.26 and 1.63 higher than in those living in non-deprived areas. There was a graded association between number of sports facilities and prevalence of physical inactivity, but no relation was found between the price of fruits and vegetables and frequency of consumption.

Conclusion

The relation of socioeconomic environment with childhood obesity could not be explained by household socioeconomic position or obesity-related risk behaviours. Availability of sport facilities may mediate this relation.