School of Public Health, Fudan University, Shanghai, China.
Eye & ENT Hospital of Fudan University, Shanghai, China.
PLoS One. 2018 Dec 3;13(12):e0207646. doi: 10.1371/journal.pone.0207646. eCollection 2018.
The objective of this study was to evaluate the factors associated with the health status of older Chinese people living in the community, in order to inform strategies to expand access to healthcare.
Two-phase stratified cluster sampling was applied; 2000 older people participated in this study. Face-to-face interviews were conducted in Shanghai between June and August, 2011. Descriptive analysis was used to examine the respondents' characteristics. Based on Andersen's healthcare utilization model, a chi-squared test and multiple logistic regression were performed to examine the influences of predisposing, enabling, need, and contextual factors on healthcare utilization.
We found that 44.5% of the older people in the sample had good self-reported health status, while 12.8% were poor, 14.5% had visited hospitals or clinics as outpatients in the previous two weeks, and 16.5% had been hospitalized in the previous year. Logistic regression analysis revealed that outpatient health services were more likely to be used by women and those whose income was from friends or social relief, who had poor to good self-reported health status, who were experiencing declining health, who engaged in volunteer activities, and who had chronic diseases. Meanwhile, hospitalization was more likely among those in the older age groups, those with pension income, living in outer suburbs, with poor self-reported health status, experiencing difficulty with activities of daily living and outdoor activities, or having a chronic disease.
The results showed the impact of economic status, health status, demographic and social characteristics, and other factors on the health service utilization of elderly people living in the community in Shanghai. Need variables were the strongest predictors of health service use, although contextual factors also contributed.
本研究旨在评估与社区中中国老年人健康状况相关的因素，以便为扩大医疗保健服务提供信息。
采用两阶段分层聚类抽样方法，共有 2000 名老年人参与了本研究。2011 年 6 月至 8 月在上海进行了面对面访谈。采用描述性分析来检查受访者的特征。基于安德森医疗保健利用模型，进行卡方检验和多因素逻辑回归，以检验倾向因素、促成因素、需求因素和环境因素对医疗保健利用的影响。
我们发现，样本中 44.5%的老年人自我报告健康状况良好，12.8%的老年人自我报告健康状况较差，14.5%的老年人在过去两周内曾到医院或诊所就诊，16.5%的老年人在过去一年中曾住院。逻辑回归分析显示，女性和收入来自朋友或社会救济的老年人、自我报告健康状况良好或较好的老年人、健康状况逐渐下降的老年人、参与志愿活动的老年人以及患有慢性病的老年人更有可能使用门诊卫生服务。同时，年龄较大的老年人、有养老金收入的老年人、居住在外郊区的老年人、自我报告健康状况较差的老年人、日常生活活动和户外活动有困难的老年人、患有慢性病的老年人更有可能住院。
研究结果表明，经济状况、健康状况、人口统计学和社会特征以及其他因素对上海社区老年人的卫生服务利用有影响。需求变量是卫生服务利用的最强预测因素，尽管环境因素也有一定影响。
