社区健康支持与老年人自评健康状况的相关性研究

背景　随着中国社会老龄化的进一步加深,近年来政府正积极推行以社区为基础的老年人健康支持模式,但是不同的社区健康支持服务与老年人健康状况的相关关系尚不明了,缺乏较为系统的研究。目的　探究当前不同形式的社区健康支持服务与老年人自评健康状况之间的相关性,为完善社区健康支持服务提供思路。方法　数据来源于“中国老年健康影响因素跟踪调查（CLHLS）”2018年截面数据,共纳入8 860例有效样本,采用倾向得分匹配（PSM）分析社区提供的起居照料、心理健康支持、上门看病和送药及健康宣教四类健康支持服务的提供与老年人自评健康状况的相关性。使用核匹配方法进行处理组（老年人所在社区提供健康支持服务）与对照组（老年人所在社区未提供健康支持服务）的匹配,默认使用二次核,带宽设定为0.06,应用K近邻匹配和半径匹配进行稳健性检验。结果　8 860例老年人自评健康状况平均得分为（3.43±0.90）分,处于一般水平。4类社区健康支持服务供给情况：887例（10.01%）老年人所在社区提供起居照料服务,3 111例（35.11%）老年人所在社区提供上门看病和送药服务,1 271例（14.35%）老年人所在社区提供精神慰藉和聊天解闷服务,3 824例（43.16%）老年人所在社区提供保健知识。不同现居地类别（城乡）、所在地区（东、中、西部地区）4类社区健康支持服务供给情况比较,差异有统计学意义（P<0.05）。PSM分析显示,社区是否提供起居照料服务与老年人自评健康状况相关,处理组老年人自评健康得分比对照组高出0.123分（ATT=0.123,P<0.05）,社区是否提供上门看病和送药服务与老年人自评健康状况之间无相关性（ATT=0.012,P>0.05）,社区是否提供精神慰藉和聊天解闷服务与老年人自评健康状况之间相关（ATT=0.083,P<0.05）,社区是否提供保健知识服务与老年人自评健康状况之间无相关性（ATT=-0.017,P>0.05）。异质性检验发现,4类健康支持服务与不同性别、年龄、学历、地区等各亚组老年群体自评健康状况的相关性检验结果与总体情况基本一致。相比于其他群体,东部城市社区、家庭年收入越高、学历越高的老年人越容易在社区健康支持服务中获益。结论　参与式的健康管理服务比被动接受式服务更有利于保持或提升老年人健康水平;社区应进一步丰富基本医疗卫生服务的供给模式,促进医疗与养老服务加速融合;推动社区健康支持服务从“大水漫灌”式逐渐走向精准化。

Community-based Health Support and Self-rated Health Status of the Elderly

Background　To address the challenges brought by accelerated aging,the Chinese government has actively promoted a model improving older people's health,namely,community-based health support model. However,the relationship of different community health support services with the health status of the elderly is unclear,and still needs to be studied systematically. Objective　To explore the association of different community-based health support services with self-rated health of older people,offering ideas for improving such services. Methods　2018 waves of the Chinese Longitudinal Healthy Longevity Survey data were obtained,with a total of 8 860 valid samples included. The relationship of self-rated health status of the elderly with four types of community-based health support services received,including personal daily care,mental health support,home visits and medication delivery,and health education,was analyzed by means of propensity score matching（PSM）. The kernel matching was used to match the processing group with the control group,with quadratic kernel used by default,and bandwidth set at 0.06. The K-nearest neighbor matching and radius matching were used to check the robustness. Results　The average score of self-rated health status of the 8 860 respondents was（3.43±0.90）,which was in the general level. The supply of 4 types of community-based health support services：10.01%（887/8 860） of the respondents received community-based personal daily care,35.11%（3 111/8 860） received community-based home visits and medication delivery,14.35%（1 271/8 860）received community-based mental comfort and chatting services for relieving boredom,and 43.16%（3 824/8 860） received community-based health education. The supply of these 4 services showed significant differences across rural and urban areas,as well as eastern,central and western China（P<0.05）. PSM analysis showed that the average self-rated health status score in the processing group was 0.123 points higher than that of the control group（ATT=0.123,P<0.05）,indicating that self-rated health status was associated with community-based personal daily care. No significant correlation existed between the self-rated health status and community-based home visits and medication delivery（ATT=0.012,P>0.05）. A significant correlation was found between community-based mental comfort and chatting services for relieving boredom and the self-rated health status. After matching,the ATT value was 0.083（P<0.05）. No significant correlation was found between community-based health education and the self-rated health status（ATT=-0.017,P>0.05）. Heterogeneity test revealed that the associations of self-rated health status with the four health support services in all participants were basically the same as those in subgroups stratified by sex,age,education level and geographical region. Those with higher annual household income,and higher education level living in urban communities of eastern China were more likely to benefit from community-based health support services. Conclusion　The participatory health management service is more beneficial to maintaining or improving the health level of the elderly than passively accepting service. Communities should further enrich the supply mode of essential medical and health services,and accelerate the integration of medical and old-age services. By doing so,the transformation of delivering community-based health support services from a pattern of "regardless of specific health needs of individuals" to the one of "precisely targeting individual specific health needs" will be promoted gradually.