社会医疗保险缓解了未成年人健康不平等吗

  目的  了解0～3岁儿童照顾模式与健康不平等的关系，为促进儿童健康发展提供参考依据。  方法   收集中国家庭追踪调查（CFPS）2018年全国数据，从中抽取1 837名0～3岁儿童，采用集中指数与分解的方法测量儿童健康不平等状况及相关贡献因素，重点分析照顾模式对儿童健康不平等的贡献。  结果  全国0～3岁儿童健康不平等指数为0.039，表明我国存在与社会经济地位相关的儿童健康不平等，来自高收入家庭的儿童普遍健康状况更好。儿童健康集中指数分解结果显示，隔代抚养与混合抚养对0～3岁儿童健康不平等的贡献率分别为4.99 %和8.04 %，一定程度造成了不平等。儿童的家庭规模（53.98 %）、年均家庭收入（38.81 %）和父亲的健康状况（23.63 %）是对儿童健康不平等贡献最大的3个要素。医疗保险和母乳喂养时长对儿童健康不平等的贡献率分别为 – 6.36 %和 – 7.56 %，有助于缩小儿童健康不平等。  结论  儿童照顾模式及相关家庭因素均对0～3岁儿童的健康有重要影响，并会造成儿童健康的不平等，应注意规避相关危险因素。

Analysis of socioeconomic health inequalities using the concentration index

  Objective   To examine the association between child rearing model and health inequality among 0 – 3 years old children and to provide references for health promotion of the children.  Methods  The data on 1 837 children aged 0 – 3 years and with valid information and the height-for-age Z-scores (HAZ) were extracted from the China Family Panel Studies (CFPS) conducted in 2018 across China. HAZ value was used to assess health status of the children. The concentration index (CI) and decomposition method were adopted to explore the children′s health inequality and its related contributing factors, especially on the contribution of child rearing model.   Results  The value of health equality CI for all the children was 0.039, indicating a minor health inequality related to socio-economic status in the children and the children from higher-income families being of better health. The decomposition analysis on health equality CI revealed that the contribution ratio of inter-generational rearing to health inequality of the children was 4.99% and that of mixed rearing was 8.04%. The family size, annual household income, and paternal health are the top three contributors to the children′s health inequality, with the contribution ratio of 53.98%, 38.81%, and 23.63%; medical insurance and breastfeeding duration are the two contributors against the health inequality, with the contribution ratio of – 6.36% and – 7.56%, respectively.   Conclusion  Child rearing model and related family factors have an important influence on the health of children aged 0 – 3 years in China, and may cause health inequality among the children.