北京市不同居住时间的农村流动人口门诊服务利用状况及其影响因素

目的：研究北京市不同累计居住时间的农村流动人口门诊服务利用状况及其主要影响因素。方法：利用2014年北京市农村流动人口健康与卫生服务调查数据，以18岁及以上农村流动人口为研究对象，以两周内是否利用门诊服务为因变量，以性别、年龄、文化程度、社会经济地位自评分、在京累计居住时间、社会医疗保险（简称：医保）状况、家庭人均月收入和是否患有高血压或糖尿病为自变量，采用Logistic回归模型进行影响因素分析。结果：研究对象平均年龄36.7岁，多为中等学历，平均在京累计居住时间为8.4年，两周患病率为10.3%，按就诊人次计算的两周就诊率为6.0%。Logistic回归结果表明，社会经济地位自评分、累计居住时间和是否患有高血压或糖尿病对门诊服务利用的影响有统计学意义。结论：研究对象是一个较为年轻、健康状况较好的人群，门诊服务利用率较低。在京累计居住时间较长的流动人口门诊服务利用率较低，主要是因为年龄标化后的两周患病率有随居住时间增加而降低的趋势，以及居住时间较长者患病后遵医嘱持续治疗的比例较高。居住时间变量在研究中具有代理变量的作用，综合反映了那些随居住时间变化却未被纳入模型的因素对门诊服务利用的影响。

Analysis on status and determinants of outpatient service utilization of rural floating population in Beijing at different residence time

Objective: To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time.Methods: The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object.Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables.Logistic regression model was used to analyze the influencing factors.Results: The average age of the research object was 36.7 years, with mostly secondary education.The average accumulated residence time in Beijing was 8.4 years.The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%.The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization.Conclusion: The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower.It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization.This is because people with longer residence time have lower age-adjusted two-week prevalence rate.This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice.It does not mean people with longer residence time have lower utilization of medical service.The residence time variable plays the role of proxy variable.It can solve the problem of variables' endoge-neity.At the same time, it can reflect the influence to outpatient services utilization of some determinants,which are not included in the model but varies with residence time.