我国老年人自评健康现状及影响因素分析
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摘要
目的了解我国≥60岁老年人的自评健康状况,并探讨其影响因素,为提高老年健康水平提供参考。方法利用2013年中国慢性病及其危险因素监测收集的相关信息,将51 255名≥60岁的常住居民作为研究对象。老年人自评健康状况问题参考美国行为危险因素调查(BRFSS)。样本复杂加权后,计算自评健康状况的总体分布及健康受到疾病、伤害、心理和情绪问题影响的比例。采用SAS 9.4软件进行χ2检验、偏比例优势模型和logit模型分析。结果老年人自评健康状况为好、一般、差的比例分别为28.82%(95%CI:27.19%～30.45%)、55.34%(95%CI:54.00%～56.69%)和15.84%(95%CI:14.78%～16.90%)。偏比例优势模型结果显示,自评健康状况随着年龄增高、受教育程度降低、地区从东部到中部再到西部,自评健康状况逐渐变差(P<0.05,P<0.01)。农村、女性老年人自评健康状况更差(P<0.01)。老年人过去30 d疾病率为33.78%(95%CI:31.03%～36.52%),伤害率为12.49%(95%CI:9.59%～15.39%),心理和情绪问题率为18.96%(95%CI:16.08%～21.85%)。logit模型结果显示,随着年龄的增加,疾病率增加,农村、西部地区、女性有更高的疾病率(OR值分别为1.10、1.79和1.28,P<0.01)。西部、农村老年人伤害率更高(OR值分别为1.81、1.19,P<0.01);西部、农村、女性老年人有更高的心理情绪问题率(OR值分别为1.70、1.15和1.24,P<0.01)。结论中国老年人自评健康状况总体一般。老年人的身体及心理健康状况应该引起重视,尤其是西部地区及女性老年人,改善老年人健康状况的政策措施应更有针对性。
Objective To study the self-rated health status of Chinese senior citizens(≥60 years old),to explore influencing factors and to provide the reference for improving the health of senior citizens. Methods The data of China Chronic Disease and Risk Factor Surveillance was used to collect the related information,51 255 residents(≥60 years old) served as the subjects. The self-rated health status of Chinese senior citizens was performed according to the Behavioral Risk Factor Surveillance System(BRFSS) in the United States. The self-rated health status distribution and the ratios of impact of diseases,injuries,psychological and emotional problems on health were calculated. The χ2 test,logit model and partial proportional odds model were used to analyze the data,the used software was SAS 9.4. Results The proportions of good,general and poor in the self-rated health status of senior citizens were 28.82%(95%CI:27.19%～30.45%),55.34%(95%CI:54.00%～56.69%) and 15.84%(95%CI:14.78%～16.90%),respectively. Partial proportional odds model analysis showed that the self-rated health status gradually decreased with the age increase,the education level decrease and region from the eastern part to western part in China(P<0.05,P<0.01). The self-rated health status of rural senior citizens and female senior citizens was worse(OR values were 1.18 and 1.36,respectively;P<0.01). The morbidity,injury rate and the rate of psychological and emotional problems of senior citizens in past 30 days were33.78%(95%CI:31.03%～36.52%),12.49%(95%CI:9.59%～15.39%) and 18.96%(95% CI:16.08% ～21.85%),respectively.Logit model analysis showed that the morbidity increased with age,the morbidities in senior citizens of rural area,western area and females were much higher(OR values were 1.10,1.79 and 1.28,respectively,P<0.01);the injury rates in senior citizens of rural area and western area were higher(OR values were 1.81 and 1.19,P<0.01);the rates of psychological and emotional problems in senior citizens of western area,rural area and females were higher(OR values were 1.70,1.15 and 1.24,respectively,P<0.01).Conclusion The self-rated health status of senior citizens in China was general. More attention should be paid to the physical and mental health status of senior citizens,especially to western area population and females;the policy measures for improving the health status of senior citizens should be targeted.
Objective To study the self-rated health status of Chinese senior citizens(≥60 years old),to explore influencing factors and to provide the reference for improving the health of senior citizens. Methods The data of China Chronic Disease and Risk Factor Surveillance was used to collect the related information,51 255 residents(≥60 years old) served as the subjects. The self-rated health status of Chinese senior citizens was performed according to the Behavioral Risk Factor Surveillance System(BRFSS) in the United States. The self-rated health status distribution and the ratios of impact of diseases,injuries,psychological and emotional problems on health were calculated. The χ2 test,logit model and partial proportional odds model were used to analyze the data,the used software was SAS 9.4. Results The proportions of good,general and poor in the self-rated health status of senior citizens were 28.82%(95%CI:27.19%～30.45%),55.34%(95%CI:54.00%～56.69%) and 15.84%(95%CI:14.78%～16.90%),respectively. Partial proportional odds model analysis showed that the self-rated health status gradually decreased with the age increase,the education level decrease and region from the eastern part to western part in China(P<0.05,P<0.01). The self-rated health status of rural senior citizens and female senior citizens was worse(OR values were 1.18 and 1.36,respectively;P<0.01). The morbidity,injury rate and the rate of psychological and emotional problems of senior citizens in past 30 days were33.78%(95%CI:31.03%～36.52%),12.49%(95%CI:9.59%～15.39%) and 18.96%(95% CI:16.08% ～21.85%),respectively.Logit model analysis showed that the morbidity increased with age,the morbidities in senior citizens of rural area,western area and females were much higher(OR values were 1.10,1.79 and 1.28,respectively,P<0.01);the injury rates in senior citizens of rural area and western area were higher(OR values were 1.81 and 1.19,P<0.01);the rates of psychological and emotional problems in senior citizens of western area,rural area and females were higher(OR values were 1.70,1.15 and 1.24,respectively,P<0.01).Conclusion The self-rated health status of senior citizens in China was general. More attention should be paid to the physical and mental health status of senior citizens,especially to western area population and females;the policy measures for improving the health status of senior citizens should be targeted.
引文
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[6]孟琴琴,张拓红.老年人健康自评的影响因素分析[J].北京大学学报(医学版),2010,42(3):258-263.
[7]孟琴琴,张拓红.健康自评指标研究进展[J].中国预防医学杂志,2010,11(7):750-752.
[8] Perlman F,Bobak M. Determinants of self-rated health and mortality in Russia-are they the same[J]. Int J Equity Health,2008,19(7):1-8.
[9]中国疾病预防控制中心,中国疾病预防控制中心慢性非传染性疾病预防控制中心.中国慢性病及其危险因素监测报告(2013)[M].北京:军事医学出版社,2016:40.
[10] BRFSS state coordinators and CDC staff. Behavioral Risk Factor Surveillance System Questionnaire[EB/OL].(2008-12-30)[2018-10-20].https://www.cdc.gov/brfss/questionnaires/pdf-ques/2009brfss.pdf.
[11]冯国双,刘德平.医学研究中的logistic回归分析及SAS实现[M].北京:北京大学医学出版社,2015:113.
[12]毕秀媛,钱占成,冯国双.用SAS软件实现偏比例优势模型[J].中国卫生统计,2011,28(6):723-725.
[13]胡楠,姜勇,李镒冲,等. 2010年中国慢病监测数据加权方法[J].中国卫生统计,2012,29(3):424-426.
[14]杜本峰,郭玉.中国老年人健康差异时空变化及其影响因素分析[J].中国公共卫生,2015,31(7):870-877.
[15]方向华,孟琛,刘向红,等.健康自评与老年人健康状况的前瞻性研究[J].中华流行病学杂志,2003,24(3):184-188.
[16]董文兰,李镒冲,王丽敏,等. 2010年中国成年人自评健康状况[J].中华预防医学杂志,2013,47(12):1137-1141.
[17]中国共产党中央委员会,中华人民共和国国务院.“健康中国2030”规划纲要[M].北京:人民出版社,2016:5.
[18]奉燕,薛志强,吴恒,等.社区老年高血压患者心理健康状况调查[J].中华全科医学,2009,31(3):289-291.
[19]陆慧,沈冲,赵启慧,等.儿童青少年血压偏高和高血压与心理行为因素关系的研究[J].中华疾病控制杂志,2014,18(8):736-739.
[2]钱军程,陈育德,孟群.中国老年人口疾病经济负担变化趋势与应对策略[J].中国卫生政策研究,2012,5(2):12-16.
[3]华颖.健康中国建设:战略意义、当前形势与推进关键[J].国家行政学院学报,2017,17(6):105-111.
[4] Crossley TF,Kenned S. The reliability of self-assessed health status[J].J Health Econ,2002,21(4):643-658.
[5] Jylha M. What is self-rated health and why does it predict mortality?Towards a unified conceptual model[J]. Soc Sci Med,2009,69(3):307-316.
[6]孟琴琴,张拓红.老年人健康自评的影响因素分析[J].北京大学学报(医学版),2010,42(3):258-263.
[7]孟琴琴,张拓红.健康自评指标研究进展[J].中国预防医学杂志,2010,11(7):750-752.
[8] Perlman F,Bobak M. Determinants of self-rated health and mortality in Russia-are they the same[J]. Int J Equity Health,2008,19(7):1-8.
[9]中国疾病预防控制中心,中国疾病预防控制中心慢性非传染性疾病预防控制中心.中国慢性病及其危险因素监测报告(2013)[M].北京:军事医学出版社,2016:40.
[10] BRFSS state coordinators and CDC staff. Behavioral Risk Factor Surveillance System Questionnaire[EB/OL].(2008-12-30)[2018-10-20].https://www.cdc.gov/brfss/questionnaires/pdf-ques/2009brfss.pdf.
[11]冯国双,刘德平.医学研究中的logistic回归分析及SAS实现[M].北京:北京大学医学出版社,2015:113.
[12]毕秀媛,钱占成,冯国双.用SAS软件实现偏比例优势模型[J].中国卫生统计,2011,28(6):723-725.
[13]胡楠,姜勇,李镒冲,等. 2010年中国慢病监测数据加权方法[J].中国卫生统计,2012,29(3):424-426.
[14]杜本峰,郭玉.中国老年人健康差异时空变化及其影响因素分析[J].中国公共卫生,2015,31(7):870-877.
[15]方向华,孟琛,刘向红,等.健康自评与老年人健康状况的前瞻性研究[J].中华流行病学杂志,2003,24(3):184-188.
[16]董文兰,李镒冲,王丽敏,等. 2010年中国成年人自评健康状况[J].中华预防医学杂志,2013,47(12):1137-1141.
[17]中国共产党中央委员会,中华人民共和国国务院.“健康中国2030”规划纲要[M].北京:人民出版社,2016:5.
[18]奉燕,薛志强,吴恒,等.社区老年高血压患者心理健康状况调查[J].中华全科医学,2009,31(3):289-291.
[19]陆慧,沈冲,赵启慧,等.儿童青少年血压偏高和高血压与心理行为因素关系的研究[J].中华疾病控制杂志,2014,18(8):736-739.