West China School of Public Health, Sichuan University, Chengdu 610041, China.
School of Public Health, Jining Medical University, Jining 272067, China.
Int J Environ Res Public Health. 2019 Mar 1;16(5):738. doi: 10.3390/ijerph16050738.
To understand the current situation and influencing factors of catastrophic health expenditure (CHE) of migrant workers in Western China. Sample data were obtained by cluster random sampling. Data were entered and sorted using Epidata 3.1 and SPSS 21.0. The statistical analysis involved a descriptive analysis, chi-square tests, multivariate unconditional logistic regression, and multiple correspondence analysis (MCA). A total of 1271 households were surveyed, and the incidence of CHE was 12.5% (159/1271). The multivariate logistic regression showed that households with elderly people over 65 years old (0R = 2.05, 95% CI = 1.42⁻2.97), children under five years old (0R = 2.61, 95% CI = 1.53⁻4.48), at least one person with no basic medical insurance (0R = 2.96, 95% CI = 2.08⁻4.23), chronically ill patients (0R = 1.85, 95% CI = 1.23⁻2.77), and hospitalized patients (0R = 3.61, 95% CI = 2.31⁻5.62) contributed to the risk of CHE. Compared to migrant workers in the >30,000 Yuan household per capita annual income group, the 10,001⁻20,000 Yuan income group (0R = 2.35, 95% CI = 1.44⁻3.82) and ≤10,000 Yuan income group (0R = 3.72, 95% CI = 2.09⁻6.62) had a higher risk of CHE occurrence. Compared to migrant workers in the university and above head-of-household education group, those in the primary level or below education group (0R = 5.90, 95% CI = 3.02⁻11.5) had a higher risk of CHE occurrence. MCA revealed a strong interrelationship between the following risk factors and CHE: household per capita annual income ≤10,000 Yuan, primary school education level or below for the head of the household, and having at least one person in the household with no basic medical insurance. CHE incidence amongst migrant workers in Western China is a serious issue, and policymakers should pay more attention to these migrant workers' households that are more prone to CHE than others, so as to decrease the incidence of CHE in this group.
为了解中国西部农民工灾难性卫生支出（ CHE ）的现状及其影响因素。采用整群随机抽样的方法获取样本数据。采用 Epidata 3.1 和 SPSS 21.0 进行数据录入和整理。统计分析包括描述性分析、卡方检验、多因素非条件 logistic 回归和多元对应分析（ MCA ）。共调查 1271 户家庭， CHE 发生率为 12.5%（159/1271）。多因素 logistic 回归显示，家中有 65 岁以上老人（ OR = 2.05 ， 95% CI = 1.42⁻2.97 ）、5 岁以下儿童（ OR = 2.61 ， 95% CI = 1.53⁻4.48 ）、至少一人无基本医疗保险（ OR = 2.96 ， 95% CI = 2.08⁻4.23 ）、慢性病患者（ OR = 1.85 ， 95% CI = 1.23⁻2.77 ）、住院患者（ OR = 3.61 ， 95% CI = 2.31⁻5.62 ）的家庭， CHE 风险增加。与人均年收入 30000 元以上的农民工相比，10001⁻20000 元收入组（ OR = 2.35 ， 95% CI = 1.44⁻3.82 ）和≤10000 元收入组（ OR = 3.72 ， 95% CI = 2.09⁻6.62 ） CHE 发生风险更高。与家庭中户主受教育程度为大学及以上的农民工相比，家庭中户主受教育程度为小学及以下的农民工（ OR = 5.90 ， 95% CI = 3.02⁻11.5 ） CHE 发生风险更高。 MCA 揭示了以下危险因素与 CHE 之间的强烈相互关系：家庭人均年收入≤10000 元、户主小学及以下教育水平、家庭中至少有一人无基本医疗保险。中国西部农民工 CHE 发生率较高，政策制定者应更加关注此类农民工家庭，这些家庭发生 CHE 的风险高于其他家庭，以降低该人群 CHE 的发生率。
