基于PLS-SEM模型的老年人慢性病影响因素分析
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摘要
目的研究老年人慢性病的影响因素,为老年人慢性病的防治提供有效的建议和措施。方法对黑龙江省第五次卫生服务调查数据进行整理,筛选60岁以上的老年人作为研究对象,影响因素设定为健康行为、身体功能、人际网络、物质条件和社会支持五个维度,采用偏最小二乘-结构方程模型(PLS-SEM)进行统计分析。结果研究样本的慢性病患病率为56.52%。测量模型的组合信度估计值均大于0.8,数据信度良好;因素负荷量的估计值在0.56~0.89之间,均达到可接受水平;平均变异萃取量(AVE)均大于0.5,表明潜变量从观察变量处获得了很好的解释信息。健康行为、身体功能、物质条件和社会支持四个维度与慢性病的发生均呈负相关,健康行为和患病情况的路径系数为-0.395、身体功能和患病情况的路径系数为-0.306、物质条件和患病情况的路径系数为-0.340、社会支持和患病情况的路径系数为-0.244。结论健康行为、身体功能、物质条件和社会支持这四个维度对慢性病有直接作用,同时与人际网络共同构建出复杂的路径实现了对慢性病的综合影响。其中健康行为是慢性病的首要影响因素,健康行为的养成有利于控制慢性病的发生发展;老年人身体功能的退化增加慢性病发生的风险;物质条件和社会支持的提升有利于降低慢性病的发病率,提高老年慢性病患者的生活质量。
Objective To study the influencing factors of chronic diseases among the elderly so as to provide effective advice and measures for their chronic disease prevention and treatment. Methods We sorted the data from the Fifth Health Service Survey in Heilongjiang Province,and then selected the elderly aged 60 years and above to serve as the research subjects. The influencing factors were divided into five dimensions,namely health behavior,physical function,interpersonal network,material condition and social support. Statistical analysis was performed by partial least squares structural equation modeling( PLS-SEM). Results The prevalence rate of chronic diseases in the research subjects was 56.52%. The composite reliability estimates of the measurement models were all more than 0.8,meaning the reliability of the data was good. The estimates of the factor loadings were between 0.56-0.89,showing the models were acceptable. The average variance extracted( AVE) values were more than 0.5,indicating latent variables could be well explained by the observation variables. Health behavior,physical function,material condition and social support were all negatively correlated with the occurrence of chronic diseases. The path coefficients of health behavior with chronic diseases,physical function with chronic diseases,material condition with chronic diseases,and social support with chronic diseases were-0.395,-0.306,-0.340 and-0.244 respectively. Conclusions Health behavior,physical function,material condition and social support have direct effects on chronic diseases; meanwhile,they interact with interpersonal network to build a complex path and generate the synthetic action on the chronic diseases. Among them,health behavior is the primary factor influencing chronic diseases,and the formation of health behavior is conducive to controlling the occurrence and development of chronic diseases. Degradation of body function of the elderly increases the risk of chronic diseases,but improvement of material condition and social support is helpful for lowering the prevalence rate of chronic diseases and promoting the quality of life in the elderly with chronic diseases.
Objective To study the influencing factors of chronic diseases among the elderly so as to provide effective advice and measures for their chronic disease prevention and treatment. Methods We sorted the data from the Fifth Health Service Survey in Heilongjiang Province,and then selected the elderly aged 60 years and above to serve as the research subjects. The influencing factors were divided into five dimensions,namely health behavior,physical function,interpersonal network,material condition and social support. Statistical analysis was performed by partial least squares structural equation modeling( PLS-SEM). Results The prevalence rate of chronic diseases in the research subjects was 56.52%. The composite reliability estimates of the measurement models were all more than 0.8,meaning the reliability of the data was good. The estimates of the factor loadings were between 0.56-0.89,showing the models were acceptable. The average variance extracted( AVE) values were more than 0.5,indicating latent variables could be well explained by the observation variables. Health behavior,physical function,material condition and social support were all negatively correlated with the occurrence of chronic diseases. The path coefficients of health behavior with chronic diseases,physical function with chronic diseases,material condition with chronic diseases,and social support with chronic diseases were-0.395,-0.306,-0.340 and-0.244 respectively. Conclusions Health behavior,physical function,material condition and social support have direct effects on chronic diseases; meanwhile,they interact with interpersonal network to build a complex path and generate the synthetic action on the chronic diseases. Among them,health behavior is the primary factor influencing chronic diseases,and the formation of health behavior is conducive to controlling the occurrence and development of chronic diseases. Degradation of body function of the elderly increases the risk of chronic diseases,but improvement of material condition and social support is helpful for lowering the prevalence rate of chronic diseases and promoting the quality of life in the elderly with chronic diseases.
引文
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[23]王新军,郑超.医疗保险对老年人医疗支出与健康的影响[J].财经研究,2014,40(1):65-75.
[24]彭小宸,邵蓉.新医改下我国基本医疗资源配置均等性研究[J].现代商贸工业,2013,34(1):24-27.
[25]柏青,苏夏伟,褚春燕,等.建立区域影像系统对于优化医疗资源分配的影响[J].中国公共卫生管理,2015,31(6):815-816.
[26]马维红,李琦.社区卫生服务对慢性病健康管理的研究进展[J].中国初级卫生保健,2011,25(1):85-87.
[27]全英玲,杨丽黎,黄美丽.富阳市农村中老年人生活行为习惯与健康状况调查分析[J].护理与康复,2011,10(9):757-759.
[28]余敏,闫涛蔚,张祥林.老年人幸福指数指标体系研究[J].商业文化月刊,2011,18(11):293-294.
[2]李耘.老年医学面临的挑战与对策[J].北京医学,2016,38(10):971-972.
[3]毛瑛,朱斌,刘锦林,等.健康生态学视角下中老年人群慢性病影响因素实证[J].西安交通大学学报社会科学版,2015,5(1):15-24.
[4]范涛,曹乾,蒋露露,等.老年人慢性病影响因素的健康生态学模型解释[J].中国全科医学,2012,15(1):33-36.
[5]陈琦,梁万年,孟群.结构方程模型及其应用[J].中国卫生统计,2004,21(1):70-74.
[6]沈阿强,季婷,娄健.基于PLS-SEM模型的电信客户忠诚度研究[J].北京邮电大学学报(社会科学版),2007,9(1):45-50.
[7]Ali F.A comparative study of CB-SEM and PLS-SEM for theory development in hospitality research[C].3rd World Research Summit for Tourism and Hospitality and 1st USA-China Tourism Research Summit:Transforming Partnerships,2015.
[8]Wong KK.Partial least square structural equation modeling(PLSSEM)techniques using Smart PLS[J].Market Bull,2013,24(1):1-32.
[9]Hair JF,Ringle CM,Sarstedt M.PLS-SEM:indeed a silver bullet[J].J Market Theor Pract,2011,19(2):139-152.
[10]李道胜.批发商关系品质与客户忠诚关系实证研究[J].商业经济研究,2013,7(1):21-22.
[11]裴宇慧,万献,罗琼佳,等.自我管理培训对老年慢性病患者“知、信、行”的影响[J].中国初级卫生保健,2014,28(1):39-41.
[12]蒲亨萍,汪晓媛,黄家容.社区护理服务对社区老年人慢性病管理的意义[J].社区医学杂志,2016,14(1):82-84.
[13]孙伟,李文玲,杨雪静,等.天津市和平区慢性病及其影响因素调查分析[J].实用预防医学,2016,23(6):726-727.
[14]朱颖杰,姚宇航,徐珊珊,等.吉林省老年人慢性病患病现状、疾病谱分布及其主要疾病危险因素分析[J].吉林大学学报(医学版),2013,39(6):1275-1281.
[15]Korda RJ,Paige E,Yiengprugsawan V,et al.Income-related inequalities in chronic conditions,physical functioning and psychological distress among older people in Australia:cross-sectional findings from the 45 and up study[J].BMC Public Health,2014,14(1):741.
[16]苏桦,张丹霞,董时广,等.2014年深圳市福田区空巢老人抑郁孤独情绪状况及影响因素分析[J].实用预防医学,2016,23(8):942-946.
[17]张玉芳,邹凌燕.城市中老年人心理健康对自理能力的影响[J].护理学杂志,2010,25(1):69-71.
[18]薛卫红,胡青,承红.加强高龄老年慢性病病人家属的心理疏导对病人生活质量的影响[J].全科护理,2016,14(18):1881-1883.
[19]龙莹.心理疏导疗法在改善老年慢性病患者应对行为中的作用[J].心理医生,2015,17(1):82-83.
[20]李德华.山东省农村居民慢性病相关知识与行为危险因素调查与研究[D].济南:山东大学,2008.
[21]隋雪梅,张丽娜,郭桂明.高血压病患者遵医行为的调查分析[J].中华现代临床医学杂志,2005,3(17):1834-1838.
[22]陶阳红,张开金,陈积瑞,等.参加城镇职工基本医疗保险的慢性病患者住院费用的影响因素调查[J].中国全科医学,2015,18(7):811-813.
[23]王新军,郑超.医疗保险对老年人医疗支出与健康的影响[J].财经研究,2014,40(1):65-75.
[24]彭小宸,邵蓉.新医改下我国基本医疗资源配置均等性研究[J].现代商贸工业,2013,34(1):24-27.
[25]柏青,苏夏伟,褚春燕,等.建立区域影像系统对于优化医疗资源分配的影响[J].中国公共卫生管理,2015,31(6):815-816.
[26]马维红,李琦.社区卫生服务对慢性病健康管理的研究进展[J].中国初级卫生保健,2011,25(1):85-87.
[27]全英玲,杨丽黎,黄美丽.富阳市农村中老年人生活行为习惯与健康状况调查分析[J].护理与康复,2011,10(9):757-759.
[28]余敏,闫涛蔚,张祥林.老年人幸福指数指标体系研究[J].商业文化月刊,2011,18(11):293-294.
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