广东省部分城市中青年居民慢性病及卫生服务需求与利用现状的调查
|
摘要
研究背景和目的意义
WHO估计2005年全球有5800万人死亡。其中,慢性病是导致死亡与伤残的主要原因,尤其是不发达和欠发达国家的主要死因。上个世纪70年代末,中国的疾病谱已经开始发生转变,慢性病所致的死亡已占据死亡原因的前三位。随着改革开放的深入和全球经济一体化进程的加快,思想观念、生活方式的多元化,竞争压力的不断加剧,中青年作为社会的主流群体,在适应社会变革和竞争环境方面所承受的心理、生理压力不断增加,然而却往往忽略了健康投资。据统计,中国死亡率最集中的年龄段正在向30岁至40岁人群逼近。
我国在20世纪90年代开始重视对慢性病的预防和控制工作,然而,防控工作进展却相当缓慢。造成这种局面的最主要原因是对慢性病的流行现状、疾病负担和卫生服务需求尚没有比较全面的数据。目前,广东省除了少数城市已经开展过局限人群的慢性病流行病学调查外,尚缺乏全省范围的信息,特别是针对中青年人群健康需求方面的调查研究。
为此我们开展本项调查研究,目的是从我省中青年人群特点出发,了解其慢性病现患状况、发病危险因素、疾病负担、卫生服务需求等,为有针对性地制定该人群的慢性病预防控制策略、合理配置卫生资源与构建和谐卫生服务城市提供详细的本底资料和政策依据。
研究对象与方法
1.调查对象:广东省部分城市15岁～60岁的常住人口。主要来自广州、深圳、东莞、佛山、珠海、惠州、江门、湛江、中山、河源、汕尾、英德等12个城市。
2.方法:把广东省各城市按照GDP排序划分为发达、欠发达和不发达三类,在这三类城市中,采用非概率的判断抽样方法,抽取≥15岁至＜60岁的人群10000人进行调查。调查对象填写问卷调查表,内容包括社会人口学特征、慢性病患病情况、两周患病情况、两周就诊情况、对社区卫生服务需求和利用情况等。共回收有效问卷8915份,有效问卷回收率为89.2%。调查数据输入Epidata3.02建立数据库。采用Spss13.0进行统计分析,包括统计描述、Pearson卡方检验、Wilcoxon秩和检验、Spearman秩相关检验等进行分析。调查实施严格的质量控制和质量考核。
研究结果
1.广东省中青年居民慢性病患病现状及有关影响因素如下:
(1)患有≥1种慢性病患病率平均为33.30%,其中男性患病率为32.91%,女性为35.52%,女性患病率显著高于男性(x~2=6.574,P=0.01)
(2)调查对象患慢性病患病率最高的前十种疾病依次是慢性胃肠道疾病(9.2%)、长期失眠(4.5%)、慢性皮肤病(4.3%)、慢性鼻炎或慢性咽炎(3.8%)、慢性过敏性疾病(3.6%)、高血压(2.6%)、龋齿或慢性牙周炎(2.3%)、慢性眼睛疾病(1.7%)、长期腰背痛(1.7%)、胆结石或慢性胆囊炎(1.6%)。
(3)并非所有慢性病的患病率均随年龄的增加而上升,患病率随年龄上升而增加主要有慢性胃炎或肠道疾病、高血压和腰背痛。
(4)不同职业人群常患慢性病的种类有所不同:脑力劳动者以胃炎或肠道疾病、失眠、慢性鼻炎或咽炎和高血压多见;体力劳动者则以口腔、慢性眼睛疾病和腰背痛为多见;学生主要患病为皮肤病和失眠。
2.疾病负担及影响因素:
(1)调查人群中享有基本医疗保险比例仅为26.1%,无任何医疗保险比例高达35.8%。
(2)10.8%调查对象医疗费用占总收入≥8%,有43.1%的调查对象则对医疗费用支配情况不清楚。
(3)经济收入与两周患病率和住院率呈负相关,与年就诊率呈弱的正相关。
3.卫生服务需求与利用情况
(1)两周患病率为26.8%;男性两周患病率(24.9%)显著低于女性(28.8%);15-19岁年龄组和55-59岁年龄组两周患病率最高。
(2)两周就诊率为18.1%。女性两周就诊率为26.3%,显著高于男性的16.8%。两周就诊率远低于两周患病率。两周患病未就诊率为46.8%。
(3)年住院率为19.3%。随年龄增加,年住院率上升;职业方面,住院率最低为城市农民工和学生;男性住院率高于女性。
(4)居民患病后选择医疗机构的原因依次是医生技术好、离家近、价格便宜或设备好、医生态度好。
(5)有68.5%调查对象表示居住地附近(步行1小时内)有医疗服务机构,但分别只有17.4%和13.4%的人对医院医生和社区卫生服务表示满意。
(6)只有53%的调查对象能经常获取保健知识,获取保健知识的最主要途径是广播电视、报纸书籍。
(7)有41.9%的调查对象健康体检次数＜1次/年。有62.8%的居民希望得到定期健康体检服务。
(8)卫生服务需求与年龄、文化程度、职业等因素有关。
结论
1.广东省城市中青年居民慢性病患病患病情况和卫生服务需求与利用状况具有该人群的特点。慢性病患病率低于宋秀玲等于2004年度调查的广东省城乡全人口患病率(41.44%)。
2.本人群主要慢性病干预方向为慢性胃肠道疾病炎等化系统疾病、长期失眠等精神方面疾病、慢性皮肤疾病,龋齿和慢性牙周炎等口腔疾病。
3.样本人群对定期体检的需求率最高。
4.年龄、性别、职业、经济收入、文化程度等因素不同程度地影响着该人群慢性病患病情况、两周患病情况、就医情况、卫生服务需求和利用情况。应根据该人群特点合理配置卫生资源和开展卫生服务。
建议
1.重点加强高发疾病防治工作,建立社区慢病管理模式。根据中青年这一特殊人群特点开展健康教育工作,坚持预防为主。
2.制定并实施区域卫生,合理调整卫生资源配置,形成城市卫生服务新格局和乡镇卫生院室一体化管理;加大政府对卫生事业的投入,并向预防保健、农村卫生、社区卫生服务和卫生执法方面倾斜。
3.深化卫生机构运行机制改革,促进卫生资源和病例向基层流动;以需求为导向,加强城市社区卫生网络建设,为社会居民提供方便、快捷、廉价、优质的全方位的社区医疗卫生服务。
4.多管齐下,抑制医疗费用不合理增长,扩大人群医保覆盖率,将社区卫生服务纳入医保范围,增加居民对社区卫生服务的利用。
6.紧密结合实际,提高卫生服务科研水平。加强全科型医学人才培养,加强社区医护人员在引导社区居民就医工作中的作用。
7.构筑卫生服务新体
Background and Purposes
It is estimated by WHO that there were 58,000,000 deaths globally in 2005. The main culprit was chronic disease causing deaths and casualties,especially in undeveloped and less developed countries.In the late seventies of last century, spectrum of disease in China had begun to change.Death caused by chronic diseases has become the first three reasons.With deepening of opening and reform policy,acceleration of global economic integration,multielement transformation of concepts and life styles,and unceasing intensifying of rivalry and pressure,young and middle aged civilians,as the main stream of society,shoulder increasing psychological and physiological pressures so as to adapt the transformation of society and rivalry.However,they usually ignore health investments.It is estimated that the focusing age interval with higher mortality is impending over people from 30 to 40 years of age.
It is not until the nineties of 20~(th) century did China begin to put great emphasis on the prevention and control of chronic diseases,with slow speed,however.The reason for the present situation is that there are not comparatively complete data of prevalent status quo,disease burden and health services demands for chronic diseases. At present,except that a few cities in Guangdong Province have carried out epidemiological investigation on chronic diseases in localized civilians,there is a scarcity of information on a whole provincial scale,especially investigative study on health demands for young and middle aged civilians.
The objective of our investigative study is to know about the status quo,risk factors,disease burden,and health services demands for chronic diseases in young and middle aged civilians.This will provide background data and policy evidences for purposedly formulation of preventative and controlling strategies,allocation of health resources reasonably,and construction of harmonious health services.
Study Groups and Methods
1.Investigative group:Stationary population≥15～60 years of age in some cities in Guangdong Province was chosen.
2.Methods:Cities in Guangdong Province were classified as developed,less developed and undeveloped ones according to GDP.In these three kinds of cities,10,000 people were selected from≥15 to＜60 according to non-probabilistic judging sampling methods.Investigative parameters include social demographic characteristics,conditions of chronic diseases,conditions of illnesses within two weeks,conditions of visiting doctors within two weeks, social services demands and utilization.Investigative data were input into Epidata3.02 and data bank was constructed.Spss13.0 was used for statistical analysis including statistical description,Pearson chi square test,and Wilcoxon rank sum test\Spearman rank correlation.The investigation follows strict quality control and evaluation.
Results
1.Twelve cities from Guangzhou,Shenzhen,Dongguan,Foshan,Zhuhai,Huizhou, Jiangmen,Zhanjiang,Zhongshan,Heyuan,Shanwei and Yingde were selected. 8,915 valid questionnaires were taken back with recovery rate 89.2%.
2.Status quo of chronic diseases of young and middle aged civilians in Guangdong Province and correlated influential factors
(1) The average morbidity rate of chronic diseases is 32.6%,with males' 38.6% and females' 26.6%.
(2) The top ten chronic diseases are in order as follows:chronic gastrointestinal tract diseases(9.2%),long-term insomnia(4.5%),dermatologic diseases (4.3%),chronic rhinitis and pharyngitis(3.8%),allergy(3.6%),hypertension (2.6%),dental caries and paradentitis(2.3%),eye diseases(1.7%),long-term lumbodorsal pain(1.7%),and gallstone or cholecystitis(1.6%).
(3) Not all morbidity rates of chronic diseases rise with the increasing of ages except chronic gastritis or intestinal diseases,hypertension and lumbodorsal pain.
(4) Chronic diseases vary in different professions.Gastrointestinal diseases, insomnia,chronic rhinitis or pharyngitis,and hypertension are commonly seen in intellectual working people.Dental ailments,eye diseases and lumbodorsal pain are common in manual workers.Dermatologic diseases and insomnia are seen in students.
3.Disease burden and influential factors
(1) The ratio of fundamental medical insurance is only 26.1%.Ratio without any medical insurance is 35.8%.
(2) Medical cost occupies≥8%in 10.8%investigative people.43.1%people are unaware of the distribution of their medical costs.
(3) Economic income is negatively correlated with two-week morbidity rate.
4.Health services demands and utilization
(1) Two-week morbidity rate is 26.8%,with males'(24.9%),significantly lower than females'(28.8%).Morbidity rates are highest in age groups 15-19 and 55-59.
(2) Two-week visiting rate is 18.1%,with females'(26.3%),significantly higher than males'(16.8%).Two-week visiting rate is significantly lower than Two-week morbidity rate.Two-week non-visiting rate is 46.8%.
(3) Annual admission rate is 19.3%.Annual admission rate increases with ages. With respect to profession,city farmer workers and students share the lowest admission rate.Admission rate of men is higher than women.
(4) Reasons of choosing medical services in residents with diseases are in order: perfect skills of doctors,close to home,lower in price or good equipments, and good attitudes of doctors.
(5) 68.5%of investigative people claim there are medical service institutions within one hour's walking distance.However,only 17.4%and 13.4% people are satisfied with the doctors and community services.
(6) Only 53%investigative people can often obtain health care information, mostly from broadcasts and television,newspaper and magazines.
(7) 41.9%of investigative people have less than once per year of health checkup. 62.8%residents hope to get regular health checkup services.
(8) Health services demands are correlated with age,educational level and profession.
Conclusion
Prevalence of chronic diseases in young and middle aged civilians in Guangdong Province possesses specificity.Factors like age,sex,profession,economic income, educational level,and so on affect to some extent prevalence of chronic diseases, two-week morbidity,visiting status,health services demands and utilization. Reasonable allocation of health resources and health care should be carried out according to the characteristics of the specific civilians.
WHO估计2005年全球有5800万人死亡。其中,慢性病是导致死亡与伤残的主要原因,尤其是不发达和欠发达国家的主要死因。上个世纪70年代末,中国的疾病谱已经开始发生转变,慢性病所致的死亡已占据死亡原因的前三位。随着改革开放的深入和全球经济一体化进程的加快,思想观念、生活方式的多元化,竞争压力的不断加剧,中青年作为社会的主流群体,在适应社会变革和竞争环境方面所承受的心理、生理压力不断增加,然而却往往忽略了健康投资。据统计,中国死亡率最集中的年龄段正在向30岁至40岁人群逼近。
我国在20世纪90年代开始重视对慢性病的预防和控制工作,然而,防控工作进展却相当缓慢。造成这种局面的最主要原因是对慢性病的流行现状、疾病负担和卫生服务需求尚没有比较全面的数据。目前,广东省除了少数城市已经开展过局限人群的慢性病流行病学调查外,尚缺乏全省范围的信息,特别是针对中青年人群健康需求方面的调查研究。
为此我们开展本项调查研究,目的是从我省中青年人群特点出发,了解其慢性病现患状况、发病危险因素、疾病负担、卫生服务需求等,为有针对性地制定该人群的慢性病预防控制策略、合理配置卫生资源与构建和谐卫生服务城市提供详细的本底资料和政策依据。
研究对象与方法
1.调查对象:广东省部分城市15岁～60岁的常住人口。主要来自广州、深圳、东莞、佛山、珠海、惠州、江门、湛江、中山、河源、汕尾、英德等12个城市。
2.方法:把广东省各城市按照GDP排序划分为发达、欠发达和不发达三类,在这三类城市中,采用非概率的判断抽样方法,抽取≥15岁至＜60岁的人群10000人进行调查。调查对象填写问卷调查表,内容包括社会人口学特征、慢性病患病情况、两周患病情况、两周就诊情况、对社区卫生服务需求和利用情况等。共回收有效问卷8915份,有效问卷回收率为89.2%。调查数据输入Epidata3.02建立数据库。采用Spss13.0进行统计分析,包括统计描述、Pearson卡方检验、Wilcoxon秩和检验、Spearman秩相关检验等进行分析。调查实施严格的质量控制和质量考核。
研究结果
1.广东省中青年居民慢性病患病现状及有关影响因素如下:
(1)患有≥1种慢性病患病率平均为33.30%,其中男性患病率为32.91%,女性为35.52%,女性患病率显著高于男性(x~2=6.574,P=0.01)
(2)调查对象患慢性病患病率最高的前十种疾病依次是慢性胃肠道疾病(9.2%)、长期失眠(4.5%)、慢性皮肤病(4.3%)、慢性鼻炎或慢性咽炎(3.8%)、慢性过敏性疾病(3.6%)、高血压(2.6%)、龋齿或慢性牙周炎(2.3%)、慢性眼睛疾病(1.7%)、长期腰背痛(1.7%)、胆结石或慢性胆囊炎(1.6%)。
(3)并非所有慢性病的患病率均随年龄的增加而上升,患病率随年龄上升而增加主要有慢性胃炎或肠道疾病、高血压和腰背痛。
(4)不同职业人群常患慢性病的种类有所不同:脑力劳动者以胃炎或肠道疾病、失眠、慢性鼻炎或咽炎和高血压多见;体力劳动者则以口腔、慢性眼睛疾病和腰背痛为多见;学生主要患病为皮肤病和失眠。
2.疾病负担及影响因素:
(1)调查人群中享有基本医疗保险比例仅为26.1%,无任何医疗保险比例高达35.8%。
(2)10.8%调查对象医疗费用占总收入≥8%,有43.1%的调查对象则对医疗费用支配情况不清楚。
(3)经济收入与两周患病率和住院率呈负相关,与年就诊率呈弱的正相关。
3.卫生服务需求与利用情况
(1)两周患病率为26.8%;男性两周患病率(24.9%)显著低于女性(28.8%);15-19岁年龄组和55-59岁年龄组两周患病率最高。
(2)两周就诊率为18.1%。女性两周就诊率为26.3%,显著高于男性的16.8%。两周就诊率远低于两周患病率。两周患病未就诊率为46.8%。
(3)年住院率为19.3%。随年龄增加,年住院率上升;职业方面,住院率最低为城市农民工和学生;男性住院率高于女性。
(4)居民患病后选择医疗机构的原因依次是医生技术好、离家近、价格便宜或设备好、医生态度好。
(5)有68.5%调查对象表示居住地附近(步行1小时内)有医疗服务机构,但分别只有17.4%和13.4%的人对医院医生和社区卫生服务表示满意。
(6)只有53%的调查对象能经常获取保健知识,获取保健知识的最主要途径是广播电视、报纸书籍。
(7)有41.9%的调查对象健康体检次数＜1次/年。有62.8%的居民希望得到定期健康体检服务。
(8)卫生服务需求与年龄、文化程度、职业等因素有关。
结论
1.广东省城市中青年居民慢性病患病患病情况和卫生服务需求与利用状况具有该人群的特点。慢性病患病率低于宋秀玲等于2004年度调查的广东省城乡全人口患病率(41.44%)。
2.本人群主要慢性病干预方向为慢性胃肠道疾病炎等化系统疾病、长期失眠等精神方面疾病、慢性皮肤疾病,龋齿和慢性牙周炎等口腔疾病。
3.样本人群对定期体检的需求率最高。
4.年龄、性别、职业、经济收入、文化程度等因素不同程度地影响着该人群慢性病患病情况、两周患病情况、就医情况、卫生服务需求和利用情况。应根据该人群特点合理配置卫生资源和开展卫生服务。
建议
1.重点加强高发疾病防治工作,建立社区慢病管理模式。根据中青年这一特殊人群特点开展健康教育工作,坚持预防为主。
2.制定并实施区域卫生,合理调整卫生资源配置,形成城市卫生服务新格局和乡镇卫生院室一体化管理;加大政府对卫生事业的投入,并向预防保健、农村卫生、社区卫生服务和卫生执法方面倾斜。
3.深化卫生机构运行机制改革,促进卫生资源和病例向基层流动;以需求为导向,加强城市社区卫生网络建设,为社会居民提供方便、快捷、廉价、优质的全方位的社区医疗卫生服务。
4.多管齐下,抑制医疗费用不合理增长,扩大人群医保覆盖率,将社区卫生服务纳入医保范围,增加居民对社区卫生服务的利用。
6.紧密结合实际,提高卫生服务科研水平。加强全科型医学人才培养,加强社区医护人员在引导社区居民就医工作中的作用。
7.构筑卫生服务新体
Background and Purposes
It is estimated by WHO that there were 58,000,000 deaths globally in 2005. The main culprit was chronic disease causing deaths and casualties,especially in undeveloped and less developed countries.In the late seventies of last century, spectrum of disease in China had begun to change.Death caused by chronic diseases has become the first three reasons.With deepening of opening and reform policy,acceleration of global economic integration,multielement transformation of concepts and life styles,and unceasing intensifying of rivalry and pressure,young and middle aged civilians,as the main stream of society,shoulder increasing psychological and physiological pressures so as to adapt the transformation of society and rivalry.However,they usually ignore health investments.It is estimated that the focusing age interval with higher mortality is impending over people from 30 to 40 years of age.
It is not until the nineties of 20~(th) century did China begin to put great emphasis on the prevention and control of chronic diseases,with slow speed,however.The reason for the present situation is that there are not comparatively complete data of prevalent status quo,disease burden and health services demands for chronic diseases. At present,except that a few cities in Guangdong Province have carried out epidemiological investigation on chronic diseases in localized civilians,there is a scarcity of information on a whole provincial scale,especially investigative study on health demands for young and middle aged civilians.
The objective of our investigative study is to know about the status quo,risk factors,disease burden,and health services demands for chronic diseases in young and middle aged civilians.This will provide background data and policy evidences for purposedly formulation of preventative and controlling strategies,allocation of health resources reasonably,and construction of harmonious health services.
Study Groups and Methods
1.Investigative group:Stationary population≥15～60 years of age in some cities in Guangdong Province was chosen.
2.Methods:Cities in Guangdong Province were classified as developed,less developed and undeveloped ones according to GDP.In these three kinds of cities,10,000 people were selected from≥15 to＜60 according to non-probabilistic judging sampling methods.Investigative parameters include social demographic characteristics,conditions of chronic diseases,conditions of illnesses within two weeks,conditions of visiting doctors within two weeks, social services demands and utilization.Investigative data were input into Epidata3.02 and data bank was constructed.Spss13.0 was used for statistical analysis including statistical description,Pearson chi square test,and Wilcoxon rank sum test\Spearman rank correlation.The investigation follows strict quality control and evaluation.
Results
1.Twelve cities from Guangzhou,Shenzhen,Dongguan,Foshan,Zhuhai,Huizhou, Jiangmen,Zhanjiang,Zhongshan,Heyuan,Shanwei and Yingde were selected. 8,915 valid questionnaires were taken back with recovery rate 89.2%.
2.Status quo of chronic diseases of young and middle aged civilians in Guangdong Province and correlated influential factors
(1) The average morbidity rate of chronic diseases is 32.6%,with males' 38.6% and females' 26.6%.
(2) The top ten chronic diseases are in order as follows:chronic gastrointestinal tract diseases(9.2%),long-term insomnia(4.5%),dermatologic diseases (4.3%),chronic rhinitis and pharyngitis(3.8%),allergy(3.6%),hypertension (2.6%),dental caries and paradentitis(2.3%),eye diseases(1.7%),long-term lumbodorsal pain(1.7%),and gallstone or cholecystitis(1.6%).
(3) Not all morbidity rates of chronic diseases rise with the increasing of ages except chronic gastritis or intestinal diseases,hypertension and lumbodorsal pain.
(4) Chronic diseases vary in different professions.Gastrointestinal diseases, insomnia,chronic rhinitis or pharyngitis,and hypertension are commonly seen in intellectual working people.Dental ailments,eye diseases and lumbodorsal pain are common in manual workers.Dermatologic diseases and insomnia are seen in students.
3.Disease burden and influential factors
(1) The ratio of fundamental medical insurance is only 26.1%.Ratio without any medical insurance is 35.8%.
(2) Medical cost occupies≥8%in 10.8%investigative people.43.1%people are unaware of the distribution of their medical costs.
(3) Economic income is negatively correlated with two-week morbidity rate.
4.Health services demands and utilization
(1) Two-week morbidity rate is 26.8%,with males'(24.9%),significantly lower than females'(28.8%).Morbidity rates are highest in age groups 15-19 and 55-59.
(2) Two-week visiting rate is 18.1%,with females'(26.3%),significantly higher than males'(16.8%).Two-week visiting rate is significantly lower than Two-week morbidity rate.Two-week non-visiting rate is 46.8%.
(3) Annual admission rate is 19.3%.Annual admission rate increases with ages. With respect to profession,city farmer workers and students share the lowest admission rate.Admission rate of men is higher than women.
(4) Reasons of choosing medical services in residents with diseases are in order: perfect skills of doctors,close to home,lower in price or good equipments, and good attitudes of doctors.
(5) 68.5%of investigative people claim there are medical service institutions within one hour's walking distance.However,only 17.4%and 13.4% people are satisfied with the doctors and community services.
(6) Only 53%investigative people can often obtain health care information, mostly from broadcasts and television,newspaper and magazines.
(7) 41.9%of investigative people have less than once per year of health checkup. 62.8%residents hope to get regular health checkup services.
(8) Health services demands are correlated with age,educational level and profession.
Conclusion
Prevalence of chronic diseases in young and middle aged civilians in Guangdong Province possesses specificity.Factors like age,sex,profession,economic income, educational level,and so on affect to some extent prevalence of chronic diseases, two-week morbidity,visiting status,health services demands and utilization. Reasonable allocation of health resources and health care should be carried out according to the characteristics of the specific civilians.
引文
1 WHO.The World Health Report[J].2002
2 贾恩志 徐耀初 沈洪兵,等.我国慢性病的疾病负担及其防治策略.中国慢性病预防与控制,2001,6(2):49-51
3 Lorig KR,Mazonson PD,Holman HR.Evidence suggesting that health education for self - management in patient with chronic arthritis has sustained health benefits which reducing health care costs[J].Arthritis and Rheumatism,1993,36:439-446
4 李立明,吕筠.慢性非传染性疾病预防与控制策略新进展[J].中国慢性病预防与控制,2003,11(3):97-98
5 陆铁琳.工作压力过大,生活方式不良——中青年已成心脏病猝死高危人群,健康报,2004-4-30
6 饶克勤,丁国伟,徐玲,等.城市贫困和脆弱人群卫生服务的需要、需求和疾病经济负担分析[J].中国卫生经济,2003,22:19-20
7 陈静,程茂金,陈翔,等.深圳市职工卫生服务利用分析[J].中国卫生经济,1998,17:34-35
8 叶浩森,王同兴,田怀谷,等.珠海市香洲社区卫生服务利用及其影响因素分析[J].中国全科医学,2005,8(23):1990-1992
9 汪凯,王国庆,李钋,等.黑水县居民医疗需要和卫生服务利用研究[J].中国卫生事业管理,1999,15:376-379
10 何廷尉.预防医学和社会医学[M].成都:四川科技出版社,1995:24-40
11 李兰娟.浙江省卫生服务供需状况分析[J].卫生经济研究,2000,17:10-11
12 黄文涌,宋沈超,张婷芬.贵阳市社区儿童2周就诊率影响因素分析[J].中国初级卫生保健1998,12:24-25.
13 黄毅敏,陈敬波,张镜源,等.闽西地区居民医疗服务评价[J].中国初级卫生保健,1995,9:13-14
14 余祖新,戴民霞,虢玲侠,等.陕西省居民住院卫生服务利用状况研究[J].中国卫生资源,2005,8:123-125
15 卢祖洵,刘军安,彭绩,等.深圳市社区卫生服务利用及其影响因素分析[J].中华医院管理杂志,2005,21:464-467
16 邹宇华,张弛,张冬梅,等.社区居民就医意向与卫生服务利用研究[J].中 国卫生经济,2004,23:15-17
17 王亚东,关静,李静,等.社区卫生服务机构与医院就诊患者满意度比较[J].中国全科医学,2006,9:1050
18 朱建军.民营社区卫生服务机构的自身建设和需求探索[J].中国全科医学,2005,8:1212
19 包士峰,张雷.城市居民卫生服务状况纵向分析[J].全科医学,20069(19):1650-1653
20 黄茂盛,洪震,曾军,等.上海市城乡老年人慢性病现况调查[J].中国老年医学杂志,2001,20(4):287-289
21 葛建霞,杨柯君.上海市2005名老年人健康状况评估分析[J].社区医学杂志,2004,2(2):6-7
22 曾小敏,宋艳艳,孙振球.城市居民接受社区卫生服务的影响因素调查和分析[J].中国卫生统计,2001,18(5):259-262
23 吴秀云,马风云,李曼春,等.城市居民社区卫生服务意向影响因素分析[J].中国全科医学,2000,3(3):194-196.
24 吴群鸿,马亚娜,赵亚双,等.城市社区卫生服务需求及影响因素研究[J].中国卫生经济,1998,17(10):14-16
25 许可,应晓华,胡善联,等.城市贫困人口医疗救助的必要性[J].中国卫生政策,1999,2(3):14-15
26 J.P.Vaughan.Health Interyiew Surveys in Developing Countries[J],EPC Puboication,4:1984
27 The Health of Canadians,Canada Health Survey,Research and Analysis Section[J].Health Div-ision,Statistics Canaea,Ottawa,KIAov7.
28 K.L.White etal,HeaIth Services:Consepts and Information for National Planning and Managemnt WHO,Public Health Papers,1977
29 耿贯一.流行病学.第2版[M].北京:人民卫生出版社,1996.823-843
30 卫生部统计信息中心.中国卫生服务调查研究:第3次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004
31 李鲁.社会医学[M].北京:人民卫生出版社,2003:128-146.
32 Tayler DJ,Lichestein KL,Durrence HH.Insomnia as a health factor [J].Behav Sleep Med,2003,1(4):227-247.
33 Rosekind MR.The epidemiology occurrence of insomnia[J].J Psychiatry,1992,53(Suppl):4-6
34 Morrison DN,McGee R,Stancon WR,et al.Sleep problem ado-lescence[J].J Am Acad Child Adolesc Psychiatry,1992,(1):94-99.
35 许新东.大学生健康教育学概论[M].南京:东南大学出版,1991.237
36 徐归燕,计会民.失眠病人的护理[J].国外医学·护理学分册,1994,13(3):103-105
37 郭莲舫,童静娴,肖泽萍.心理障碍的健康教育和健康促进[J].中国全科医学,2002,5(11).867-869
38 李融,蔡志强,侯钢.失眠症的焦虑、抑郁症状的调查[J].中国行为医学科学,2002,11(5):530-531
39 Milagros C,Rosal D,Judith,et al.Behavioral risk factors among members of a health maintenance organization[J].PreventiveMedicine,2001,33:586.
40 卢祖洵.社会医学[M].北京:科学出版社,2003.90-160
41 Doll R,Yang GH,Chen ZM,et al.Emerging tobacco hazards in China:Early mortality results from a prospective study[J].BMJ,1998,317:1423-1424.
42 许燕君,马文军,徐浩锋,等.广东省≥15岁居民吸烟模式及影响因素分析[J].中国公共卫生,2005,21(8):899-901
43 马冠生,孔灵芝,栾德春,等.中国居民吸烟行为的现状分析[J].中国慢性病预防与控制,2005,13(5):195-199
44 姚崇华,刘姝倩,左惠娟,等.我国心血管流行概况[J].心肺血管病杂志,1999,18(4):241-244
45 The World Health Report 1997.Conquering suffering enriching humanity.Geneva,World Health Orgnization,1997
46 Christopher JL Murray,Alan D Lopez.The Global Burden of Disease.Geneva,Switzerland World Health Orgnization,1997
47 王立义.社区慢性病管理面临的挑战与对策[J].上海预防医学杂志,2003,15(9):475-476
48 王立义.城区慢性病的监测[J].中国初级卫生保健,1996,10(10):38.
49 施学忠,杨永利,谢婧,等.河南省中老年人慢性病患病及影响因素分析[J].中国公共卫生,2005,21(6):717-719
50 孙纪新,王新立,卢安,等.河北省2003年城乡居民慢性病患病状况调查[J]. 现代预防医学,2005,32(12):1702-1705
51 力晓蓉,易易,冯昌琪,等.四川省城乡居民慢性病患病调查[J].预防医学情报杂志,2005,21(2):139-142
52 姜昌梅,韩少梅,张孔来.中国城乡老年人生活质量综合评价[J].中国卫生统计,2000,17(6):348-350
53 Booth FW,Lees S.Fundamental questions about genes,inactivity,and chronic diseases[J].Physiol Genomics,2006:174
54 Hung HC,Joshipura KJ,Jiang R,Hu FB,et al.Fruit and vegetable intake and risk of major chronic disease[J].Natl Cancer Inst.2004;96(21):1577-84
55 CDC.Prevalence of selected risk factors for chronic disease-Jordan,2002[J].MMWR,2003;52:1042-1044
56 Murray CJL.Quantifying the burden of disease:the technical basis for disability-adjusted life years[J].Bulletin of the World Health Organization,1994,72:429
57 Murray CJL,Lopez AD.Quantifying disability:data,methods and result [J].Bulletin ofthe World Health Organization,1994,72:481
58 World Bank.Development Report 1993:investingin health[M].Oxford UniversityPress,1993:25-36
59 梁万年,王红,杨兴华.中国城市社区卫生服务评价指标体系的建立[J].中国卫生事业管理,2002,18(8):460-462
60 施学忠,李颖琰,郗园林.河南省城乡居民健康状况调查与卫生服务对策[J].郑州大学学报(医学版),2003,38(3):380-383
61 倪赛男.城市社区卫生服务模式的探讨[J].中国卫生事业管理2001,6(9):358
62 杜雪平,张晓林.以居民健康需求为导向的社区卫生服务模式探讨[J].中国全科医学,1999,2(4):150-152
63 吴秀云,李曼春,马凤云.城市社区卫生服务内容及服务对象构成分析[J].中国初级卫生保健,2002,14(12):5-6
64 郭清,王小全,汪胜,等.中国城市2005年社区卫生服务评价指标及操作方法研究[J].中国全科医学,2002,5(12):973-974
65 郭清,汪胜,王小全,等.中国城市社区卫生服务评价指标研究[J].中国全 科医学,2002,5(11):887-888
66 于跃,程晓明,蔡伟,等.宁夏石嘴山市社区卫生服务项目成本测算研究[J].中国全科医学,2003,6(2):123-125
67 陈文,吴凡,应晓华,等.社区基本预防服务的成本测算[J].中国卫生经济,2003,22(1):45-48
68 吴凡,陈文,应晓华等.社区基本预防服务界定及其成本测算研究[J].中国卫生经济,2002,21(9):20-21
69 张宇,肖十力,张拓江,等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究[J].中国全科医学,2003,(2):123-125
70 姚岚,陈启鸿,陈迎春,等.社区卫生服务与城镇职工基本医疗保险的政策效应分析[J].中国全科医学,2002,5(1):43-44
71 董军,李小华,王保真.影响老年社区卫生服务需求的主要因素分析[J].中国卫生事业管理,2001,17(1)
72 李军,姜润生,祁秉先,等.昆明、个旧两市社区卫生服务运行成本分析[J].中国医院管理,2003,23(4):20-22
73 刘伟,江一民.社区卫生服务中心流程再造[J].中华医院管理,2005,21(3):188-189
74 刘艳,吴群鸿.哈尔滨市社区卫生服务需求、利用及影响因素分析[J].中国卫生事业管理,2002,18(2):101-102
75 郑振,黄小凤.福建省城市居民对医疗卫生咨询与指导性服务收费意愿调查[J].中国全科医学,2002,5(3):216-217
76 董沛,魏瑞璞.社区卫生服务中老年群体的需求[J].中国初级卫生保健,2000,14(3):49
77 黄敬亨,健康教育学[M].上海:复旦大学出版社,1997
78 顾缓.我国城市基层医院向全科医疗转变问题讨论[J].全科医学杂志,1996,(1):42
79 郎晓东,李曼春.社区卫生人力资源的现状与需求探讨[J].中国初级卫生保健,2002,16(10):4-5
80 蒋忠,严东明.盐城市城乡居民健康状况及卫生服务需求调查分析[J].中国全科医学.2003,6(1):46-48
81 顾缓.全科医学理论与实践[J].世界图书出版公司,1995,19,
82 鲍勇,高修银,顾森,等.徐州市社区居民健康状况和卫生服务需求分析以 及对策研究[J].中国全科医学,2003,6:449-452
83 薛迪斯.加强以家庭为基础的长期保健的发展[J].中国初级卫生保健,2002,16(10):12
84 应桂英.改革后社区卫生服务面临的机遇和挑战[J].中国卫生事业管理,2001(12):738-74
85 行为危险因素监测.1996年监测报告.
86 左惠娟,姚崇华,胡先芝等.社区医疗保健服务需求定性调查分析[J].中国慢性病预防与控制杂志.2000,8(6):275-277
87 吕姿之主编.健康教育与健康促进[M].北京医科大学,中国协和医科大学联合出版社,1998
88 严迪英主编.健康促进干预——方法与应用[M].北京医科大学,北京协和医科大学联合出版社,1998
89 Christine L Paul,Selina Kedman.A review of The effectivenessof print material in change health-related knowledge,attitude and behavior[J].Health Promotion Journal of Australia 1997;7(2):91-99
90 宋秀玲,马文军,许燕君,等,广东省2004年城乡居民自报慢性病患病状况调查[J],华南预防医学2007,10,33(5)
91 童伊晖,郭强,徐国桓.高科技条件下医疗卫生资源配里中的效益和公平问题[J].医学情报工作,2004(4):250-252
92 吴国安,雷海潮,杨炳生,等,卫生资源配置标准研究的方法学评述[J].国卫生资源,2001,4(6):271-274
93 邹宇华,楚慧珠,李奕明,等,广东省卫生资源配里现状分析[J].华南预防医,2004.30(3):65-67
94 马文军.广东省慢性非传染性疾病流行及防治现状[J],华南预防医学2006,2,32(1)
95 杨悦,尹戎.关于中国卫生资金配置的评价与思考[J].中国卫生事业管理2004(9):526-528
2 贾恩志 徐耀初 沈洪兵,等.我国慢性病的疾病负担及其防治策略.中国慢性病预防与控制,2001,6(2):49-51
3 Lorig KR,Mazonson PD,Holman HR.Evidence suggesting that health education for self - management in patient with chronic arthritis has sustained health benefits which reducing health care costs[J].Arthritis and Rheumatism,1993,36:439-446
4 李立明,吕筠.慢性非传染性疾病预防与控制策略新进展[J].中国慢性病预防与控制,2003,11(3):97-98
5 陆铁琳.工作压力过大,生活方式不良——中青年已成心脏病猝死高危人群,健康报,2004-4-30
6 饶克勤,丁国伟,徐玲,等.城市贫困和脆弱人群卫生服务的需要、需求和疾病经济负担分析[J].中国卫生经济,2003,22:19-20
7 陈静,程茂金,陈翔,等.深圳市职工卫生服务利用分析[J].中国卫生经济,1998,17:34-35
8 叶浩森,王同兴,田怀谷,等.珠海市香洲社区卫生服务利用及其影响因素分析[J].中国全科医学,2005,8(23):1990-1992
9 汪凯,王国庆,李钋,等.黑水县居民医疗需要和卫生服务利用研究[J].中国卫生事业管理,1999,15:376-379
10 何廷尉.预防医学和社会医学[M].成都:四川科技出版社,1995:24-40
11 李兰娟.浙江省卫生服务供需状况分析[J].卫生经济研究,2000,17:10-11
12 黄文涌,宋沈超,张婷芬.贵阳市社区儿童2周就诊率影响因素分析[J].中国初级卫生保健1998,12:24-25.
13 黄毅敏,陈敬波,张镜源,等.闽西地区居民医疗服务评价[J].中国初级卫生保健,1995,9:13-14
14 余祖新,戴民霞,虢玲侠,等.陕西省居民住院卫生服务利用状况研究[J].中国卫生资源,2005,8:123-125
15 卢祖洵,刘军安,彭绩,等.深圳市社区卫生服务利用及其影响因素分析[J].中华医院管理杂志,2005,21:464-467
16 邹宇华,张弛,张冬梅,等.社区居民就医意向与卫生服务利用研究[J].中 国卫生经济,2004,23:15-17
17 王亚东,关静,李静,等.社区卫生服务机构与医院就诊患者满意度比较[J].中国全科医学,2006,9:1050
18 朱建军.民营社区卫生服务机构的自身建设和需求探索[J].中国全科医学,2005,8:1212
19 包士峰,张雷.城市居民卫生服务状况纵向分析[J].全科医学,20069(19):1650-1653
20 黄茂盛,洪震,曾军,等.上海市城乡老年人慢性病现况调查[J].中国老年医学杂志,2001,20(4):287-289
21 葛建霞,杨柯君.上海市2005名老年人健康状况评估分析[J].社区医学杂志,2004,2(2):6-7
22 曾小敏,宋艳艳,孙振球.城市居民接受社区卫生服务的影响因素调查和分析[J].中国卫生统计,2001,18(5):259-262
23 吴秀云,马风云,李曼春,等.城市居民社区卫生服务意向影响因素分析[J].中国全科医学,2000,3(3):194-196.
24 吴群鸿,马亚娜,赵亚双,等.城市社区卫生服务需求及影响因素研究[J].中国卫生经济,1998,17(10):14-16
25 许可,应晓华,胡善联,等.城市贫困人口医疗救助的必要性[J].中国卫生政策,1999,2(3):14-15
26 J.P.Vaughan.Health Interyiew Surveys in Developing Countries[J],EPC Puboication,4:1984
27 The Health of Canadians,Canada Health Survey,Research and Analysis Section[J].Health Div-ision,Statistics Canaea,Ottawa,KIAov7.
28 K.L.White etal,HeaIth Services:Consepts and Information for National Planning and Managemnt WHO,Public Health Papers,1977
29 耿贯一.流行病学.第2版[M].北京:人民卫生出版社,1996.823-843
30 卫生部统计信息中心.中国卫生服务调查研究:第3次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004
31 李鲁.社会医学[M].北京:人民卫生出版社,2003:128-146.
32 Tayler DJ,Lichestein KL,Durrence HH.Insomnia as a health factor [J].Behav Sleep Med,2003,1(4):227-247.
33 Rosekind MR.The epidemiology occurrence of insomnia[J].J Psychiatry,1992,53(Suppl):4-6
34 Morrison DN,McGee R,Stancon WR,et al.Sleep problem ado-lescence[J].J Am Acad Child Adolesc Psychiatry,1992,(1):94-99.
35 许新东.大学生健康教育学概论[M].南京:东南大学出版,1991.237
36 徐归燕,计会民.失眠病人的护理[J].国外医学·护理学分册,1994,13(3):103-105
37 郭莲舫,童静娴,肖泽萍.心理障碍的健康教育和健康促进[J].中国全科医学,2002,5(11).867-869
38 李融,蔡志强,侯钢.失眠症的焦虑、抑郁症状的调查[J].中国行为医学科学,2002,11(5):530-531
39 Milagros C,Rosal D,Judith,et al.Behavioral risk factors among members of a health maintenance organization[J].PreventiveMedicine,2001,33:586.
40 卢祖洵.社会医学[M].北京:科学出版社,2003.90-160
41 Doll R,Yang GH,Chen ZM,et al.Emerging tobacco hazards in China:Early mortality results from a prospective study[J].BMJ,1998,317:1423-1424.
42 许燕君,马文军,徐浩锋,等.广东省≥15岁居民吸烟模式及影响因素分析[J].中国公共卫生,2005,21(8):899-901
43 马冠生,孔灵芝,栾德春,等.中国居民吸烟行为的现状分析[J].中国慢性病预防与控制,2005,13(5):195-199
44 姚崇华,刘姝倩,左惠娟,等.我国心血管流行概况[J].心肺血管病杂志,1999,18(4):241-244
45 The World Health Report 1997.Conquering suffering enriching humanity.Geneva,World Health Orgnization,1997
46 Christopher JL Murray,Alan D Lopez.The Global Burden of Disease.Geneva,Switzerland World Health Orgnization,1997
47 王立义.社区慢性病管理面临的挑战与对策[J].上海预防医学杂志,2003,15(9):475-476
48 王立义.城区慢性病的监测[J].中国初级卫生保健,1996,10(10):38.
49 施学忠,杨永利,谢婧,等.河南省中老年人慢性病患病及影响因素分析[J].中国公共卫生,2005,21(6):717-719
50 孙纪新,王新立,卢安,等.河北省2003年城乡居民慢性病患病状况调查[J]. 现代预防医学,2005,32(12):1702-1705
51 力晓蓉,易易,冯昌琪,等.四川省城乡居民慢性病患病调查[J].预防医学情报杂志,2005,21(2):139-142
52 姜昌梅,韩少梅,张孔来.中国城乡老年人生活质量综合评价[J].中国卫生统计,2000,17(6):348-350
53 Booth FW,Lees S.Fundamental questions about genes,inactivity,and chronic diseases[J].Physiol Genomics,2006:174
54 Hung HC,Joshipura KJ,Jiang R,Hu FB,et al.Fruit and vegetable intake and risk of major chronic disease[J].Natl Cancer Inst.2004;96(21):1577-84
55 CDC.Prevalence of selected risk factors for chronic disease-Jordan,2002[J].MMWR,2003;52:1042-1044
56 Murray CJL.Quantifying the burden of disease:the technical basis for disability-adjusted life years[J].Bulletin of the World Health Organization,1994,72:429
57 Murray CJL,Lopez AD.Quantifying disability:data,methods and result [J].Bulletin ofthe World Health Organization,1994,72:481
58 World Bank.Development Report 1993:investingin health[M].Oxford UniversityPress,1993:25-36
59 梁万年,王红,杨兴华.中国城市社区卫生服务评价指标体系的建立[J].中国卫生事业管理,2002,18(8):460-462
60 施学忠,李颖琰,郗园林.河南省城乡居民健康状况调查与卫生服务对策[J].郑州大学学报(医学版),2003,38(3):380-383
61 倪赛男.城市社区卫生服务模式的探讨[J].中国卫生事业管理2001,6(9):358
62 杜雪平,张晓林.以居民健康需求为导向的社区卫生服务模式探讨[J].中国全科医学,1999,2(4):150-152
63 吴秀云,李曼春,马凤云.城市社区卫生服务内容及服务对象构成分析[J].中国初级卫生保健,2002,14(12):5-6
64 郭清,王小全,汪胜,等.中国城市2005年社区卫生服务评价指标及操作方法研究[J].中国全科医学,2002,5(12):973-974
65 郭清,汪胜,王小全,等.中国城市社区卫生服务评价指标研究[J].中国全 科医学,2002,5(11):887-888
66 于跃,程晓明,蔡伟,等.宁夏石嘴山市社区卫生服务项目成本测算研究[J].中国全科医学,2003,6(2):123-125
67 陈文,吴凡,应晓华,等.社区基本预防服务的成本测算[J].中国卫生经济,2003,22(1):45-48
68 吴凡,陈文,应晓华等.社区基本预防服务界定及其成本测算研究[J].中国卫生经济,2002,21(9):20-21
69 张宇,肖十力,张拓江,等.社区卫生服务机构与医院双向转诊实现途径和管理办法的研究[J].中国全科医学,2003,(2):123-125
70 姚岚,陈启鸿,陈迎春,等.社区卫生服务与城镇职工基本医疗保险的政策效应分析[J].中国全科医学,2002,5(1):43-44
71 董军,李小华,王保真.影响老年社区卫生服务需求的主要因素分析[J].中国卫生事业管理,2001,17(1)
72 李军,姜润生,祁秉先,等.昆明、个旧两市社区卫生服务运行成本分析[J].中国医院管理,2003,23(4):20-22
73 刘伟,江一民.社区卫生服务中心流程再造[J].中华医院管理,2005,21(3):188-189
74 刘艳,吴群鸿.哈尔滨市社区卫生服务需求、利用及影响因素分析[J].中国卫生事业管理,2002,18(2):101-102
75 郑振,黄小凤.福建省城市居民对医疗卫生咨询与指导性服务收费意愿调查[J].中国全科医学,2002,5(3):216-217
76 董沛,魏瑞璞.社区卫生服务中老年群体的需求[J].中国初级卫生保健,2000,14(3):49
77 黄敬亨,健康教育学[M].上海:复旦大学出版社,1997
78 顾缓.我国城市基层医院向全科医疗转变问题讨论[J].全科医学杂志,1996,(1):42
79 郎晓东,李曼春.社区卫生人力资源的现状与需求探讨[J].中国初级卫生保健,2002,16(10):4-5
80 蒋忠,严东明.盐城市城乡居民健康状况及卫生服务需求调查分析[J].中国全科医学.2003,6(1):46-48
81 顾缓.全科医学理论与实践[J].世界图书出版公司,1995,19,
82 鲍勇,高修银,顾森,等.徐州市社区居民健康状况和卫生服务需求分析以 及对策研究[J].中国全科医学,2003,6:449-452
83 薛迪斯.加强以家庭为基础的长期保健的发展[J].中国初级卫生保健,2002,16(10):12
84 应桂英.改革后社区卫生服务面临的机遇和挑战[J].中国卫生事业管理,2001(12):738-74
85 行为危险因素监测.1996年监测报告.
86 左惠娟,姚崇华,胡先芝等.社区医疗保健服务需求定性调查分析[J].中国慢性病预防与控制杂志.2000,8(6):275-277
87 吕姿之主编.健康教育与健康促进[M].北京医科大学,中国协和医科大学联合出版社,1998
88 严迪英主编.健康促进干预——方法与应用[M].北京医科大学,北京协和医科大学联合出版社,1998
89 Christine L Paul,Selina Kedman.A review of The effectivenessof print material in change health-related knowledge,attitude and behavior[J].Health Promotion Journal of Australia 1997;7(2):91-99
90 宋秀玲,马文军,许燕君,等,广东省2004年城乡居民自报慢性病患病状况调查[J],华南预防医学2007,10,33(5)
91 童伊晖,郭强,徐国桓.高科技条件下医疗卫生资源配里中的效益和公平问题[J].医学情报工作,2004(4):250-252
92 吴国安,雷海潮,杨炳生,等,卫生资源配置标准研究的方法学评述[J].国卫生资源,2001,4(6):271-274
93 邹宇华,楚慧珠,李奕明,等,广东省卫生资源配里现状分析[J].华南预防医,2004.30(3):65-67
94 马文军.广东省慢性非传染性疾病流行及防治现状[J],华南预防医学2006,2,32(1)
95 杨悦,尹戎.关于中国卫生资金配置的评价与思考[J].中国卫生事业管理2004(9):526-528