西部农村老年人口医疗卫生服务问题研究

  目的  了解中西部项目地区农村老年人两周患病情况及影响因素，为改善老年健康和提高卫生服务质量提供理论依据。  方法  于2018年11月 — 2019年1月，采用多阶段随机整群抽样方法，对20个项目县的14 656名 ≥ 60岁农村老年人进行调查，并运用单水平logistic回归和多水平回归统计方法分析两周患病的影响因素。  结果  调查地区老年人两周患病率为28.53 %，两周患病疾病种类主要为高血压（39.23 ‰）等慢性病，发病时间构成主要为慢性病延续到2周内（61.16 %）；多水平模型显示，女性两周患病率（19.91 %）高于男性（14.88 %）（χ² = 50.426，P < 0.001）；少数民族两周患病率（16.93 %）低于汉族（18.92 %）（χ² = 8.683，P = 0.003）；与医疗机构距离较远（2 km～或4 km～）的老年人两周患病率低于0 km～组（P < 0.05）。2周内有跌倒的老年人两周患病率（49.66 %）高于未跌倒的老年人（16.71 %）（χ² = 87.129，P < 0.001）；患有慢性病的老年人两周患病率（26.25 %）高于未患慢性病的老年人（11.72 %）（χ² = 451.492，P < 0.001）。  结论  性别、民族、与医疗机构距离、是否跌倒以及是否患有慢性病是中西部项目地区老年人两周患病率的主要影响因素；采用多水平模型比传统的logistic回归模型能更好地分析具有层次结构的资料。

The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly

  Objective  To examine the two-week prevalence of diseases and its influencing factors among the elderly in rural regions with community-based elderly health promotion program in Central and Western China for providing evidences to the improvement of elderly health and medical service to the elderly.  Methods  Using multistage random cluster sampling, we conducted a face-to-face questionnaire survey among 14 656 permanent rural residents aged 60 years and above in 20 counties with community-based elderly health promotion program in Central and Western China from November 2018 to January 2019. Univariate and multivariate logistic regression analysis were used to analyze influencing factors of two-week prevalence of diseases among the elderly residents.  Results  The total two-week prevalence rate of diseases was 28.53% among the participants and the major contributors to the two-week prevalence rate were chronic diseases, including hypertension with a two-week prevalence rate of 39.23‰; of the participants suffering from diseases during two weeks, 61.16% were patients with long-lasting chronic conditions. Multivariate analysis demonstrated that the two-week prevalence was higher among the female participants than among the male participants (19.91% vs. 14.88%, χ² = 50.426, P < 0.001); the ethnic minority participants had a lower two-week prevalence than the Han participants (16.93% vs. 18.92%, χ² = 8.683, P = 0.003); the participants living far away from a medical institution (≥ 2 kilometers) reported a higher two-week prevalence than those with a residence away from a medical institution in a distance of < 2 kilometers (P < 0.05); the participants with falling experience during the two weeks reported a significantly higher two-week prevalence than those without the experience (49.66% vs. 16.71%, χ² = 87.129, P < 0.001); the participants suffering from chronic disease reported a significantly higher two-week prevalence than those not suffering from chronic disease (26.25% vs. 11.72%, χ² = 451.492, P < 0.001).  Conclusion  Main influencing factors of two-week prevalence of diseases include gender, ethnicity, the distance from residence to a nearest medical institution, falling experience during two weeks, and chronic disease condition among elderly residents in rural regions with community-based elderly health promotion program in Central and Western China.