社区社会环境与中老年居民自评健康的相关性研究

  目的   分析社区社会环境对社区中老年居民自评健康的影响，为构建良好的社区社会环境、促进社区中老年人群健康提供依据。   方法   利用2011年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）社区和家户调查数据，选取397个社区的7 822名中老年人为研究对象。社区社会环境包括社区社会经济地位、社区社会保障和社区服务三类，自评健康采用五个等级评分。采用三水平广义线性模型分析社区社会环境对中老年自评健康的影响。   结果   自评健康不好的比例为28.8%。三水平广义线性模型结果显示，中老年居民自评健康在城市和社区层面均存在差异，并且社区水平方差缩减比达到35.71%。中、高人均纯收入社区相比低人均纯收入社区，其居民自评健康状况更好（OR=0.84，P<0.05；OR=0.70，P<0.05)。中、高文化程度社区相比低文化程度社区，其居民自评健康状况更好(OR=0.78，P<0.05；OR=0.73，P<0.05)。实行失业补贴的社区其中老年居民自评健康状况更好（OR=0.77，P<0.05）。个体水平上，患有慢性病的中老年人自评健康状况更差（OR=4.46，P<0.05）。城市的中老年自评健康状况较农村更好（OR=0.76，P<0.05）。   结论   社区社会经济地位和社区失业补贴与社区中老年居民自评健康呈正相关。需要特别关注低社会经济地位社区的中老年人健康状况，完善失业保障政策，促进社区中老年居民健康。

Correlation Study of Community Social Environment and Self-Rated Health of Middle-Aged and Older Adults

  Objective   To analyze the impact of the social environment of a community on the self-rated health of middle-aged and older adults living in the community, and to provide a basis for building favorable community social environment that promotes the health of middle-aged and older adults.   Methods   Using the community and individual survey data from China Health and Retirement Longitudinal Study (CHARLS) done in 2011, 7822 middle-aged and older adults living in 397 communities were selected as the subjects of the study. Community social environment under study included community socioeconomic status, community social security and community services. Self-rated health was measured with a five-level score. A three-level hierarchical generalized linear model (HGLM) was used to analyze the impact of community social environment on the self-rated health of middle-aged and older adults.   Results   The proportion of subjects who reported self-rated poor health was 28.8%. According to the results of the three-level HGLM, the self-rated health of middle-aged and older adults showed differences at both the city and the community levels, and the variance reduction ratio reached 35.71% at the community level. The self-rated health status of residents in the communities with medium and high net per capita income was better than that in the communities with low net per capita income (OR=0.84, P<0.05;OR=0.70, P<0.05). The self-rated health status of residents in the communities with secondary and higher education levels was better than that in the communities with low education level (OR=0.78, P<0.05;OR=0.73, P<0.05). The self-rated health of middle-aged and older adults in the communities with unemployment subsidies was much better (OR=0.77, P<0.05). The self-rated health status of middle-aged and older adults with chronic diseases was worse (OR=4.46, P<0.05). Middle-aged and older adults living in cities had better self-rated health status (OR=0.67, P<0.05).   Conclusion   Community socioeconomic status and community unemployment subsidy are positively correlated with the self-rated health of middle-aged and older adults living in the community. It is necessary to pay special attention to the health status of middle-aged and older adults in communities of low socioeconomic status, improve unemployment insurance policies, and promote the health of middle-aged and older adults.