Lan Xin, Zhou Zhongliang, Si Yafei, Shen Chi, Fan Xiaojing, Chen Gang, Zhao Dantong, Chen Xi
School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 Yanta West Road, Xi'an, 710061, Shaanxi, China.
School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
BMC Health Serv Res. 2018 Nov 20;18(1):871. doi: 10.1186/s12913-018-3698-1.
Chronic disease has become one of the leading causes of poverty in China, which posed heavy economic burden on individuals, households and society, and accounts for an estimated 80% of deaths and 70% of disability-adjusted life-years lost now in China. This study aims to assess the effect of chronic diseases on health payment-induced poverty in Shaanxi Province, China.
The data was from the 5th National Health Survey of Shaanxi Province, which was part of China's National Health Service Survey (NHSS) conducted in 2013. Totally, 20,700 households were selected for analysis. We used poverty headcount, poverty gap and mean positive poverty gap to assess the incidence, depth and intensity of poverty before and after health payment, respectively. Logistic regression models were further undertaken to evaluate the influence of percentage of chronic patients in households on the health payment-induced poverty with the control of other covariates.
In rural areas, the incidence of poverty increased 31.90% before and after health payment in the household group when the percentage of chronic patients in the households was 0, and the poverty gap rose from 932.77 CNY to 1253.85 CNY (50.56% increased). In the group when the percentage of chronic patients in the households was 1-40% and 41-50%, the poverty gap increased 76.78 and 89.29%, respectively. In the group when the percentage of chronic patients in the households was 51~ 100%, the increase of poverty headcount and poverty gap was 49.89 and 46.24%. In the logistic model, we found that the proportion of chronic patients in the households was closely related with the health payment-induced poverty. The percentage of chronic disease in the households increased by 1 %, the incidence of poverty increased by 1.01 times. On the other hand, the male household head and the household's head with higher educational lever were seen as protective factors for impoverishment.
With the percentage of chronic patients in the households growing, the health payment-induced poverty increases sharply. Furthermore, the households members with more chronic diseases in rural areas were more likely to suffer poverty than those in urban areas. Our analysis emphasizes the need to protect households from the impoverishment of chronic diseases, and our findings will provide suggestions for further healthcare reforms in China and guidance for vulnerable groups.
慢性病已成为中国贫困的主要原因之一，给个人、家庭和社会带来了沉重的经济负担，目前在中国估计占死亡人数的80%和伤残调整生命年损失的70%。本研究旨在评估慢性病对中国陕西省因健康支付导致的贫困的影响。
数据来自陕西省第五次国家卫生服务调查，该调查是2013年开展的中国国家卫生服务调查（NHSS）的一部分。总共选取了20700户家庭进行分析。我们分别使用贫困发生率、贫困差距和平均正贫困差距来评估健康支付前后贫困的发生率、深度和强度。进一步采用逻辑回归模型，在控制其他协变量的情况下，评估家庭中慢性病患者比例对因健康支付导致的贫困的影响。
在农村地区，家庭中慢性病患者比例为0时，健康支付前后家庭组贫困发生率增加了31.90%，贫困差距从932.77元上升至1253.85元（增加了50.56%）。家庭中慢性病患者比例为1 - 40%和41 - 50%时，贫困差距分别增加了76.78%和89.29%。家庭中慢性病患者比例为51 - 100%时，贫困发生率和贫困差距的增幅分别为49.89%和46.24%。在逻辑模型中，我们发现家庭中慢性病患者比例与因健康支付导致的贫困密切相关。家庭中慢性病比例每增加1%，贫困发生率增加1.01倍。另一方面，男性户主和教育水平较高的户主被视为贫困的保护因素。
随着家庭中慢性病患者比例的增加，因健康支付导致的贫困急剧增加。此外，农村地区慢性病患者较多的家庭成员比城市地区更容易陷入贫困。我们的分析强调了保护家庭免受慢性病贫困影响的必要性，我们的研究结果将为中国进一步的医疗改革提供建议，并为弱势群体提供指导。
