中国全科医学 ›› 2024, Vol. 27 ›› Issue (12): 1452-1459.DOI: 10.12114/j.issn.1007-9572.2023.0365

• 论著 • 上一篇    下一篇

我国中老年人群慢性病患病率及患病种类区域差异与医疗卫生资源的相关性研究

刘影1, 姜俊丞2, 景汇泉1,*()   

  1. 1.100069 北京市,首都医科大学公共卫生学院
    2.100086 北京市,北京中关村信息谷科技服务部
  • 收稿日期:2023-04-12 修回日期:2023-12-05 出版日期:2024-04-20 发布日期:2024-01-23
  • 通讯作者: 景汇泉

  • 作者贡献:刘影负责统计分析、文章编辑写作及修订;姜俊丞负责数据清洗、数据管理及文章审查评论;景汇泉负责数据管理、资金支持、监督及文章的审查评论等全面指导,对文章整体负责;所有作者确认了论文的最终稿。
  • 基金资助:
    国家重点研发计划项目(SQ2018YFC200162-01)

Correlation of Regional Differences in the Prevalence and Types of Chronic Diseases among Middle-aged and Elderly People with Health Resources Allocation in China

LIU Ying1, JIANG Juncheng2, JING Huiquan1,*()   

  1. 1. School of Public Health, Capital Medical University, Beijing 100069, China
    2. Technology Service Department, Beijing Zhongguancun Information Valley, Beijing 100086, China
  • Received:2023-04-12 Revised:2023-12-05 Published:2024-04-20 Online:2024-01-23
  • Contact: JING Huiquan

摘要: 背景 中国正逐渐步入老龄化社会,中老年人的健康问题越来越受到关注,其中高血压、糖尿病、冠心病、脑卒中等慢性病成为主要的健康威胁。同时,医疗卫生资源分布不均,导致地区间的医疗水平和服务质量存在差异。目的 探讨我国中老年人群慢性病患病率、患病种类区域差异与医疗卫生资源的相关性。方法 2022年10月—2023年3月研究者通过对中国健康与养老追踪调查2018年(CHARLS)数据进行清洗、整理及统计分析,共纳入19 520名≥45岁的中老年人,并选取《中国卫生统计年鉴》(2011—2020年)中的2018年统计数据作为对应的医疗卫生资源相关数据。采用多元线性回归分析的方法将各省份的床位数、卫生技术人员数[执业(助理)医师、注册护士、乡村医生和卫生员]、财政支出(卫生健康总支出)、卫生机构数(医院、基层医疗卫生机构、专业公共卫生机构)的泰尔指数与各省份中老年人慢性病患病率进行相关性分析。结果 东、中、西部地区中老年人慢性病患病率(χ2=57.900,P<0.001)、患慢性病数量(χ2=11.138,P=0.004)比较,差异有统计学意义;东、中、西部慢性地区中老年人在14种慢性病患病类型中,慢性肺部疾病(χ2=30.906,P<0.001)、肝脏疾病(χ2=17.871,P<0.001)、脑血管疾病(χ2=18.313,P<0.001)、肾脏疾病(χ2=24.383,P<0.001)、消化系统疾病(χ2=16.973,P<0.001)、记忆相关疾病(χ2=6.898,P=0.032)、哮喘(χ2=22.055,P<0.001)的患病率比较,差异有统计学意义;多元线性回归分析结果显示,中老年人慢性病总体患病状况与医院、基层医疗机构、执业(助理)医师、注册护士、乡村医生和卫生财政支出的公平性有关(P<0.05)。结论 我国东、中、西部中老年人群慢性病患病率存在区域差异,不同地区对卫生事业的投入及医疗卫生资源配置也存在一定差异。应加强重大慢性病的区域性健康管理,提高基层防病治病和健康管理能力,壮大医疗卫生人员队伍,改善医疗卫生资源区域配置公平性,从而缩短东、中、西部中老年人慢性病患病的区域差异。

关键词: 慢性病, 中老年人, 区域差异, 医疗卫生资源, 泰尔指数, 相关性

Abstract:

Background

China is gradually entering an ageing society and the health of the middle-aged and elderly is a growing concern, with chronic diseases such as hypertension, diabetes, coronary heart disease and stroke becoming major health threats. At the same time, the uneven distribution of health resources has led to regional differences in medical level and service quality.

Objective

To explore the correlation between the prevalence of chronic diseases, regional differences in the types of diseases and health care resources among middle-aged and elderly people in China.

Methods

A total of 19 520 middle-aged and older adults ≥45 years of age were selected by cleaning, organizing and statistically analyzing the data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 from October 2022 to March 2023, and 2018 statistics from the China Health Statistics Yearbook (2011-2020) were selected as the corresponding data related to health resources. Multiple linear regression analysis was used to analyze the correlation between Theil index of the number of beds, number of health technicians [practicing (assistant) physicians, registered nurses, rural doctors and health workers], financial expenditures (total health expenditure), number of health institutions (hospitals, primary care institutions, professional public health institutions) and the prevalence of chronic diseases in middle-aged and elderly people in each province.

Results

There were significant differences in the prevalence of chronic diseases (χ2=57.900, P<0.001) and the number of chronic diseases (χ2=11.138, P=0.004) among the middle-aged and elderly people living in the eastern, central and western regions. Among the 14 types of chronic diseases, there were significant differences in the prevalence of chronic lung disease (χ2=30.906, P<0.001), liver disease (χ2=17.871, P<0.001), cerebrovascular disease (χ2=18.313, P<0.001), kidney disease (χ2=24.383, P<0.001), digestive system diseases (χ2=16.973, P<0.001), memory-related diseases (χ2=6.898, P=0.032) and asthma (χ2=22.055, P<0.001) in middle-aged and elderly people living in the eastern, central and western regions of China. The results of the multiple linear regression analysis showed that the overall prevalence of chronic diseases in middle-aged and elderly people was correlated with hospitals, primary care institutions, practicing (assistant) physicians, registered nurses, rural doctors and the equity of health financial expenditures in middle-aged and elderly people (P<0.05) .

Conclusion

There are regional differences in the prevalence of chronic diseases among the middle-aged and elderly populations in the eastern, central and western parts of China, and there are also certain differences in the investment in health care and the allocation of health care resources in different regions. Regional health management of major chronic diseases should be strengthened, the ability of disease prevention and health management in primary care should be improved, medical and health personnel should be strengthened, the regional health resources allocation balance should be improved, so as to shorten the regional differences in the prevalence of chronic diseases among middle-aged and elderly people in the eastern, central and western China.

Key words: Chronic disease, Middle aged and elderly people, Regional differences, Health resources, Thiel's index, Correlation