北京市老年人慢性病社会决定因素研究

目的：研究北京市老年人慢性病在不同社会阶层人群中的患病差异。方法：利用北京大学公共卫生学院2013年对北京市老年人进行的入户调查数据库,获取1717名具有北京代表性的60岁及以上人口的入户调查信息。以收入、受教育程度、职业和户口等社会经济地位指标对社会阶层进行度量,采用Logistic回归模型,分析北京市老年人慢性病患病在不同社会阶层人群间的分布。结果：非农业户口人群、收入位于中间和最高人群、小学组和大专及以上组慢性病患病风险较低。退休前从事农林牧渔业水利业生产人员慢性病患病风险较高。收入次低20％组同时患3种以上慢性病风险较高。结论：慢性病防控策略的制定应充分考虑社会分层等健康社会决定因素,而不仅仅是针对慢性病的直接病因。北京市老年人的慢性病防控工作应当重点关注农业户口、低收入和受教育程度较低人群。     

社会经济地位对中国非在学成人高血压患病的影响

目的了解社会经济地位对中国成人高血压患病的影响,为进一步完善中国慢性病防控策略提供参考。方法利用2006年中国健康与营养调查（CHNS）成人调查问卷数据,选取18～50岁非学生样本,根据个人收入、受教育程度和职业对社会经济地位进行划分,以二分类Logistic回归模型分析不同社会经济地位人群高血压患病的差异;以多分类Logistic回归模型分析慢性病危险因素在不同社会经济地位人群中分布的差异。结果在控制年龄、性别、婚姻状况后社会经济地位低组人群患高血压的可能性比社会经济地位高组人群高68．6％（OR=1．686,95％C／：1．013-2．807）。中度以上饮酒、高盐饮食在不同社会经济地位人群间分布存在统计学差异（x＾2=124．365,P〈0．001和X＾2=21．003,P=0．007）。控制高血压危险因素后社会经济地位低组人群和较低组人群患高血压的可能性分别比社会经济地位高组人群高80．6％（OR=1．806,95％CI：l．080～3．154）和74．6％（OR=I．686,95％CI：1．009～2．885）。结论社会经济地位低组人群患高血压的可能性比社会经济地位高组人群高。     

云南省楚雄州农村居民慢性病患病现状及影响因素分析

[目的]了解楚雄州农村居民慢性病患病现状及其影响因素。[方法]采用分层整群抽样的方法,对3659户农村居民进行入户访谈。[结果]农村居民过去半年的慢性病患病率为7．2％;高血压、风湿（类风湿）、腰椎间盘突出、慢性胃肠炎、心脏病、骨质增生、肾结石、慢性阻塞性肺疾病（COPD）是楚雄州农村居民的主要慢性病;不同经济地区、年龄、文化程度、性别、婚姻状况的农村居民其慢性病患病率存在统计学差异（P〈0．001）;家庭人口数、经济状况、饮用水、居民性别、婚姻状况、年龄、文化程度是楚雄州农村居民慢性病患病率的主要影响因素。[结论]家庭人口数少、女性、老年人、受教育程度相对较低、低收入农村居民是陧性病的高危人群,建议在农村开展慢性病防控工作时将重心放在以上高危人群：区域卫生规划工作制定公共卫生资源配置标准时应综合考虑以上影响因素。     

社会经济地位与慢性病患病的关联——基于北京和上海工作群体的实证研究

目的：探索社会经济地位与慢性病患病的关联。方法：从中国家庭动态跟踪调查2009年截面调查资料中提取北京和上海两地18～60岁工作人群,采用Logistic回归模型,分析自评社会地位、工作决策自由度及收入与慢性病患病率的关系。结果：北京和上海两地,慢性病患病在不同主观社会地位、不同收入之间的分布无显著差异;而在工作决策自由度上,自由度较高者,慢性病患病风险较高。结论：工作状态与慢性病关系紧密,且在发展中国家,此种关系的趋势与发达国家的研究结果不尽相同。     

我国农村不同收入居民健康状况与生命质量研究

目的：评价不同收入农村居民的健康状况及健康相关生命质量,分析家庭经济对人群健康的影响及其健康问题的特点。方法：采用欧洲五维度健康量表对不同收入农村居民的健康状况进行测量。结果：五维度任一维度存在问题的比例随着收入的降低而增高,而VAS评分也随之降低。低收入阶层在两周患病率、慢性病患病率、年需住院率三个指标上呈现出＂三高＂的现象,应住院未住院率则随着收入的降低而增高。结果提示,低收入阶层存在的健康问题多,对卫生服务的需要高但利用低,女性人群有健康问题比例较男性高。结论与建议：经济收入对居民有较大的影响,要关注低收入老年人群和女性群体,政府应该完善健康保障制度,强化医疗救助政策,降低低收入人群卫生服务的经济障碍,提高健康和卫生服务利用的公平性。     

对农村人口健康知识及健康行为状况的调查与分析

在湖南省９６ 个县（市）中采取问卷测试及入户调查的方式,调查了农村人口１６４９６ 人分别将不同经济水平类型的农村人口之间及小学生与居民之间基础健康知识知晓率与基础健康行为形成率进行比较。结果显示：绝大多数不同经济水平类型的农村人口间及小学生与居民总体之间均存在非常显著的差异（Ｐ＜ ０．００１）。小学以下（含小学）文化程度与初中文化程度的群体间及男性居民与女性居民之间也有显著性差异（Ｐ＜ ０．０５）。提示我们：要加强农村居民的健康教育,且农村居民中女性群体的健康教育是重中之重     

温州市泰顺县农村居民健康素养状况调查

目的了解温州市农村居民的健康素养状况,探讨影响农村居民健康素养的主要因素,为制定农村健康素养干预策略提供依据。方法采用多阶段随机整群抽样方法,抽取泰顺县2个镇4个行政村共440名15~69周岁农村居民进行调查问卷调查。结果调查对象的总健康素养为6.59%,健康基本知识与理念素养为10.9%,健康生活方式和行为素养为10.5%,健康技能素养为12.3%,差异有统计学意义（χ2=8.66,P=0.03）;健康科学观、安全与急救、传染病预防、基本医疗、慢性病预防5大类健康素养的具备率分别为12.27%、33.86%、16.59%、2.73%和16.59%,差异有统计学意义（χ2=163.29,P=0.00）。除性别外,不同年龄、文化程度、经济收入、民族、职业者之间的健康素养均有统计学差异。结论加强农村健康促进与健康教育,以低文化程度人群、高年龄组人群、少数民族人群为重点对象;对不同职业、婚姻、经济状况的人群结合其实际工作、生活和学习情况,采取有针对性的干预策略与方法,提升农村居民健康素养。     

安徽省枞阳县农村居民慢性病患病率调查分析

目的：调查安徽省枞阳县农村居民2001年慢性病患病率，并与1993和1998年全国农村卫生服务调查慢性病患病率相关资料比较分析。方法：采用整群随机抽样方法对枞阳县农村居民慢性病患病率进行实地问卷调查。结果：2001年慢性病患病率高于1998年全国农村平均水平，不同性别、年龄和文化程度的人群慢性病患病率不同。结论：农村卫生服务需求量有增大的趋势。农村居民健康状况存在潜在的威胁，不同人群卫生服务需求存在一定差异。     

不同社会经济地位人群三种常见健康相关行为差异研究

近年来,众多研究显示社会经济地位是影响健康的最具有决定性的因素,收入、地位与健康之间有着非常明显的阶梯式差异[1-2],然而,其影响健康的机制却众说纷纭.不良生活方式如吸烟、酗酒和缺乏锻炼是心血管疾病和癌症的高危因素[3],低收入者、手工劳动者和缺乏教育者更容易吸烟和缺乏体育锻炼[4],显示了社会经济地位与健康相关行为有一定相关性[5].笔者利用2003年国家卫生服务调查中浙江省的资料,分析不同社会经济地位人群的3种常见健康相关行为的差异及其间的关系.     

与收入相关的健康不平等及其分解

目的:测量与收入相关的自评健康不平等程度,并分析各因素的贡献。方法:利用家庭健康询问调查数据,采用集中指数法测量居民基于收入的自评健康不平等程度及各因素对自评健康不平等的贡献。结果:不同收入人群的自评健康有差异,集中指数为0.034,仍存在亲富人的健康不平等;各因素对自评健康不平等的贡献中,收入贡献率为46.30%,地区为22.00%,性别-年龄为13.80%,城乡类型为10.10%,文化程度为7.20%。结论:收入和地区因素对自评健康不平等贡献较大;改善收入分配、缩小地区间发展差距、加快城乡一体化建设、推进教育公平等有利于降低健康不平等。     

我国农村居民自评健康状况与报告行为实证研究

目的:对我国农村居民的自评健康以及自评健康报告行为进行测量,检验自评健康指标的可靠性与稳健性。方法:采用多阶段整群抽样法抽取了3省1 800户农户进行入户调查,共有5 849名农村居民纳入分析。使用世界价值观调查表中的自评健康状况问题,EQ-5D量表以及中国一般人群健康效用值积分体系,分别测量农村居民的自评健康状况和潜在健康状况,并利用两者的系统测量误差反映报告行为。采用卡方检验与方差分析检验不同特征农村居民的自评健康与报告行为的差异性。结果:农村地区女性、65岁及以上老年人群、小学及以下低学历水平、离退休、无业或失业、低收入水平、患有多种慢性病人群中,自评健康状况为"好"的比例相比其他人群更低,这部分农村居民的自评健康状况报告行为也更加悲观。结论:我国农村居民自评健康状况与报告行为变化趋势一致。自评健康指标在测量健康水平上具有较高的可靠性与稳健性。罹患合并症的慢性病患者是慢性病健康管理的重点人群。老年人群需要得到更多支持与关注。低收入水平对报告行为的负效应强于其他收入水平。健康行为与自评健康和报告行为的关系有待进一步挖掘。     

The inequality of inpatient care net benefit under integration of urban-rural medical insurance systems in China

Background

China has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China.

Methods

Data were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits.

Results

Findings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60?years of age and over, history of chronic disease and high educational level positively influence inequality.

Conclusion

In China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.

     

Differential effects of family income on self-rated health by age: analysis of Seoul citizens health indicators survey 2001, 2005]

OBJECTIVES: This study was conducted in order to determine how the association between socioeconomic position(SEP) and health status changes with age among Seoul residents aged 25 and over. METHODS: We utilized the 2001 and 2005 Seoul Citizens Health Indicators Surveys. We used self-rated 'poor' health status as an outcome variable, and family income as an indicator of SEP. In order to characterize the differential effects of socioeconomic position on health by age, we conducted separate multivariate analyses by 10-year age groups, controlling for sociodemographic covariates. In order to assess the relative health inequality across socioeconomic groups, we estimated the Relative Index of Inequality (RII). RESULTS: The risk of 'poor health' is significantly high in low family income groups, and this increased risk is seen at all ages. However, the magnitude of relative socioeconomic inequality in health, as measured by the odds ratio and RII, is not identical across age groups. The difference in health across income groups is small in early adulthood (ages 25-34), but increases with age until relatively late in life (ages 35-64). It then decreases among the elderly population (ages more than 65). When the RII reported in 2005 is compared to that reported in 2001, RII can be seen to have increased across all ages, with the exception of individuals aged 25-34. CONCLUSIONS: The magnitude of health inequality is the greatest during mid- to late adulthood (ages 45-64). In addition, health inequalities have worsened between 2001 and 2005 across all age groups after economic crisis.     

Chronic Disease in China: Geographic and Socioeconomic Determinants Among Persons Aged 60 and Older

ObjectivesThis study aimed to reveal the epidemic characteristics of chronic diseases among the Chinese older population and provide empirical strategies for the prevention and management of chronic diseases in the seniors in China.DesignA national cross-sectional study.Setting and ParticipantsA total of 224,640 Chinese residents aged 60 and older were invited, and 222,179 (98.9%) participated in our survey.MethodsStandardized questionnaires were used to collect socioeconomic information and self-reported physician-diagnosed chronic diseases. The associations between individual socioeconomic status and chronic diseases were estimated using generalized linear mixed-effects models.ResultsThe national prevalence of any chronic diseases was 81.1% (95% CI 80.9–81.2), representing 179.9 million Chinese older adults. The prevalence increased with aging and peaked at 80 to 84 years old (87.2, 95% CI 86.7–87.7), this is consistent with studies in developing countries. Women (84.2, 84.0–84.4), rural residents (82.6, 82.4–82.8), and ethnic minorities (82.2, 81.5–82.8) had a higher prevalence than men (77.7, 77.4–77.9), urban residents (79.7, 79.5–79.9), and people of Han ethnicity (81.0, 80.8–81.2), respectively. For provincial prevalence, Tibet had the highest prevalence of chronic diseases (91.8, 91.5–92.0), and Fujian had the lowest (72.7, 72.5–72.9). The absolute differences between the highest and lowest provinces for the specific chronic condition ranged from 2.78% for cancer to 36.3% for cardiovascular diseases.Conclusions and ImplicationsChronic diseases were highly prevalent among older adults in China and varied geographically. Advanced socioeconomic status appeared to have double-edged impacts on the prevalence of chronic diseases. Our findings support that reducing gender and geographic disparities should be prioritized in China's chronic disease prevention and management, and an affordable long-term care services system for older adults should be established urgently in China.     

2012年江西省吉安市农村居民慢性病患病现况及影响因素分析

目的 了解江西省吉安市农村居民慢性病的流行现状,探索其影响因素,为慢性病的预防和控制提供理论依据.方法 采用分层整群随机抽样的方法获取样本,对吉安市4个县的2160户农村居民进行入户问卷调查.应用描述性流行病学的方法分析吉安市常住居民的慢性病患病现状,x2检验和多因素Logistic回归分析方法探索慢性病的影响因素.结果 2012年江西省吉安市农村居民的慢性病患病率为16.53％.与慢性病患病状况相关的影响因素包括年龄（OR=2.387,95％CI：2.213～2.561）、文化程度（OR=0.761,95％CI：0.742 ～0.780）、离婚或丧偶（OR=1.376,95％CI：1.238～1.514）、高收入（OR=0.667,95％CI：0.521 ～0.813）、吸烟（OR=1.824,95％CI：1.720 ～1.928）和饮酒（OR =2.145,95％CI：1.701 ～2.589）等.结论 吉安市农村居民慢性病患病率较全国水平略高,相关疾病预防控制机构应结合实际情况,针对危险因素采取积极的防治措施.     

Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold

We combine two of the most widely used measures in the inequality and poverty literature, the concentration index and Foster–Greer–Thorbecke metric to the analysis of socioeconomic inequality in obesity. This enables us to describe socioeconomic inequality not only in obesity status but also in its depth and severity. We apply our method to 1971–2012 US data and show that while the socioeconomic inequality in obesity status has now almost disappeared, this is not the case when depth and severity of obesity are considered. Such socioeconomic gradient is found to be greatest among non‐Hispanic whites, but decomposition analysis also reveals an inverse relationship between income and obesity outcomes among Mexican Americans once the effect of immigrant status has been accounted for. The socioeconomic gradient is also greater among women with marital status further increasing it for severity of obesity while the opposite is true among men. Overall, the socioeconomic gradient exists as poorer individuals lie further away from the obesity threshold. Our study stresses the need for policies that jointly consider obesity and income to support those who suffer from the double burden of poverty and obesity‐related health conditions. © 2016 The Authors. Health Economics Published by John Wiley & Sons Ltd.     

Beefing up with the Chans: evidence for the effects of relative income and income inequality on health from the China Health and Nutrition Survey

A great deal of research has examined the hypothesis that the well-being of individuals is shaped not just by the absolute level of resources available to them but also the level of resources available to them relative to others in their cohort or community. Several causal pathways have been hypothesized to explain associations between relative social position and health. For example, greater community income could increase the overall availability of health care in a community or decrease the availability for people for any given level of individual income. Relative social position could also create stress, resulting in adverse health outcomes through increased hypertension and other pathways. We explore yet another pathway by which relative social position may affect health. Specifically, to the extent that norms about physical appearance might be shaped by one's observations of others, we examine whether obesity might constitute another physiologic pathway by which community attributes could influence aspects of individual health, such as hypertension. We examine this hypothesis in rural China, where income often limits food intake so that, if community norms are an important determinant of individual obesity, higher community income could increase the obesity rate in a community and therefore change norms about obesity. These norms, in turn, could increase individuals' chances of being obese given their income. To test this hypothesis, we use multilevel linear probability models to examine the relationship between ecologic factors, i.e., relative income and income inequality, and health risk factors, i.e., obesity and hypertension among a sample of Chinese adults interviewed in four waves over 9 years. The results suggest that, among rural Chinese residents, increasing community average income and income inequality are positively associated with both obesity and hypertension. However, the effect of relative income on hypertension is not accounted for by increases in obesity. We did not find a strong relationship between socioeconomic conditions and the health risk factors among urban residents, where norms might be likely to be less strongly influenced by local attributes. Hence, the present study provides evidence supporting the hypothesis that relative income and income inequality affect obesity and hypertension, but no evidence that the effects on hypertension operated through effects on obesity.     

Equity in health and health care: the Chinese experience.

This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.     

Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States

STUDY OBJECTIVES: Few studies have analysed the rates and correlates of physical activity in economically and geographically diverse populations. Objectives were to examine: (1) urban-rural differences in physical activity by several demographic, geographical, environmental, and psychosocial variables, (2) patterns in environmental and policy factors across urban-rural setting and socioeconomic groups, (3) socioeconomic differences in physical activity across the same set of variables, and (4) possible correlations of these patterns with meeting of physical activity recommendations. DESIGN: A cross sectional study with an over sampling of lower income adults was conducted in 1999-2000. SETTING: United States. PARTICIPANTS: 1818 United States adults. Main results: Lower income residents were less likely than higher income residents to meet physical activity recommendations. Rural residents were least likely to meet recommendations; suburban residents were most likely to meet recommendations. Suburban, higher income residents were more than twice as likely to meet recommendations than rural, lower income residents. Significant differences across income levels and urban/rural areas were found for those reporting neighbourhood streets, parks, and malls as places to exercise; fear of injury, being in poor health, or dislike as barriers to exercise and those reporting encouragement from relatives as social support for exercise. Evidence of a positive dose-response relation emerged between number of places to exercise and likelihood to meet recommendations for physical activity. CONCLUSIONS: Both income level and urban rural status were important predictors of adults' likelihood to meet physical activity recommendations. In addition, environmental variables vary in importance across socioeconomic status and urban-rural areas.