中国不同地区中老年人门诊服务利用及影响因素研究

目的 分析中国不同地区中老年居民门诊服务利用现状及其影响因素。方法 基于2018年CHARLS第四次调查,将中国28个省份划分为东中西部三个地区,依据安德森模型对19 136例中老年居民门诊服务利用的影响因素采用二分类多水平Logistic回归模型进行探讨。结果 我国中老年居民慢性病患病率为44.7%,其中,西部地区慢性病患病率最高(47.3%),四周就诊率最高(18.2%); 不同地区中老年居民门诊服务利用的影响因素有所不同,东部地区,女性(男性OR=0.782,95%CI:0.675～0.905)、文化水平较高(OR=1.853,95%CI:1.197～2.869)、丧偶者(OR=1.317,95%CI:1.081～1.605)四周就诊的可能性增加; 在中部地区,参加城镇职工医保(OR=2.094,95%CI:1.123～3.903)或新农合(OR=1.952,95%CI:1.069～3.563)、轻度失能(OR=1.440,95%CI:1.099～1.885)的居民四周就诊的可能性增加; 在西部地区,女性四周就诊的可能性高于男性(OR=0.718,95%CI:0.628～0.821); 三个地区均显示自评健康状况越差、慢性病患者四周就诊的可能性更高(P＜0.05)。结论 我国不同地区中老年居民门诊服务利用的影响因素有所不同,自评健康状况和慢性病是三个地区四周就诊率相同的影响因素因此,在配置门诊医疗资源时,应针对不同地区的中老年人群特点进行合理倾斜。

Outpatient service utilization and influencing factors among middle-aged and elderly people in different regions of China

Objective To analyze the current status and influencing factors of outpatient service utilization among middle-aged and elderly people in different regions of China. Methods Based on the fourth CHARLS survey in 2018, 28 provinces were divided into three regions. Based on the Anderson model, the influencing factors of outpatient service utilization of 19136 middle-aged and elderly people were discussed by binary multi-level logistic regression model. Results The prevalence rate of chronic disease in middle-aged and elderly people in China was 44.7%, among which, the prevalence rate of chronic disease in western region was the highest(47.3%), and the rate of four-week visit rate was the highest(18.2%). The influencing factors of outpatient service utilization of middle-aged and elderly residents were different in different regions. In the eastern region, women(male OR=0.782,95%CI:0.675-0.905), people with higher educational level(OR=1.853,95%CI:1.197-2.869)and the widowed(OR=1.317,95%CI:1.081-1.605)were more likely to utilize the outpatient resources. In the central region, the possibility of four weeks medical treatment was increased for the residents who participated in the urban employee medical insurance(OR=2.094,95%CI:1.123-3.903)or the new type of rural cooperative medical insurance(OR=1.952,95%CI:1.069-3.563)), and the mild disability(OR=1.440,95%CI:1.099-1.885). In western regions, women were more likely to utilize the outpatient resources than men(OR=0.718,95%CI:0.628-0.821). All three regions showed that the worse self-rated health status, chronic disease patients were the same factors.(P＜0.05)Conclusion The influence factors of outpatient service of middle-aged and old residents in different regions are different, self-reported health status and chronic diseases are the same influence factors. Therefore, outpatient services resources should be rationally allocated according to the characteristics of different regions.