摘要
目的探索影响我国居民自评健康的因素及多层次医疗保险体系、邻里社会资本对自评健康的影响。方法基于2018年中国劳动力动态调查数据,运用Stata 15.0软件进行χ^(2)检验、单因素分析与多因素Logistic回归模型分析我国居民自评健康的影响因素;并采用交互模型分析多层次医疗保险体系、邻里社会资本对自评健康的交互作用。结果本研究调查对象共10201人,自评不健康者占39.20%;调整混杂因素后,多因素Logistic回归模型结果显示,有社会医疗保险[OR=0.8,95%CI(0.7,1.0)]、有邻里社会资本[OR=0.7,95%CI(0.6,0.8)]更倾向于自评健康。此外,男性、大专及以上学历、有工作、饮酒会增加自评不健康的风险(P<0.05);而45~59岁、60岁及以上、中西部地区、规律锻炼、两周内有病伤则会降低自评不健康的风险(P<0.05)。医疗保险与邻里社会资本和居民自评健康呈正向相乘交互作用[单因素:OR=1.5,95%CI(1.1,3.7),P<0.05;多因素:OR=1.7,95%CI(1.2,2.4),P<0.05],以及负向相加交互作用[RERI=−0.8,95%CI(−1.4,−0.1);AP=−0.3,95%CI(−0.6,−0.1);SI=0.6,95%CI(0.5,0.8)]。结论应通过健康促进与健康教育等手段关注重点人群的自评健康状况,提倡健康的行为生活方式;应进一步完善医疗保险体系,并重视邻里社会资本的作用,鼓励居民积极构建良好的社会邻里关系,实现多层次医疗保险体系与邻里社会资本的协调发展。
Objective To investigate the factors that influence Chinese residents,self-rated health and the effects of the multilevel health insurance system and neighborhood social capital on self-rated health.Methods Based on the 2018 China labor-force dynamics survey data,and Stata 15.0 software was used to conduct χ^(2) test,univariate analysis and multiple logistic regression model were used to analyze the influencing factors of self-rated health of Chinese residents.An interaction model was used to analyze the interactive effects of the multilevel health insurance system and the social capital of the neighborhood on self-rated health.Results A total of 10201 people were investigated in this study,and 39.20%of them were self-rated unhealthy.After adjusting for confounders,the results of the multivariate logistic regression model showed that having social health insurance(OR=0.8,95%CI 0.7 to 1.0)and having neighborhood social capital(OR=0.7,95%CI 0.6 to 0.8)were more inclined to self-rated health.In addition,the results showed that being male,having a college degree or higher,having a job,and drinking alcohol increased the risk of self-rated unhealthy(P<0.05);whereas being 45-59 years of age,60 years of age or older,in the central and western regions,exercising regularly,and having a disease or injury within two weeks decreased the risk of self-rated unhealthy(P<0.05).There was a positive multiplicative interaction effect between health insurance and neighborhood social capital on residents’self-rated health(univariate:OR=1.5,95%CI 1.1 to 3.7,P<0.05;multivariate:OR=1.7,95%CI 1.2 to 2.4,P<0.05),and negative additive interactions(RERI=−0.8,95%CI 1.4 to−0.1;AP=−0.3,95%CI−0.6 to−0.1;SI=0.6,95%CI 0.5 to 0.8).Conclusion Attention should be paid to the selfrated health status of key populations through means such as health promotion and education,and healthy behavior lifestyles should be promoted.The health insurance system should be further improved,and attention should be paid to the role of social capital in the neighborhood,encouraging residents to actively build a good social neighborhood,and realizing the coordinated development of the multilevel health insurance system and the social capital in the neighborhood.
作者
马亦晨
丁明峰
韩雪梅
马子媛
李婧宜
罗晓蕾
张嘉文
江靖雯
MA Yichen;DING Mingfeng;HAN Xuemei;MA Ziyuan;LI Jingyi;LUO Xiaolei;ZHANG Jiawen;JIANG Jingwen(Institute of Social Medicine and Health Management,School of Public Health,Lanzhou University,Lanzhou 730000,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2024年第7期767-775,共9页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:72274087)
甘肃省自然科学基金(编号:22JR5RA498)。
关键词
多层次医疗保险体系
邻里社会资本
自评健康
交互作用
Multilevel health insurance system
Neighborhood social capital
Self-rated health
Interaction
