Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
Int J Environ Res Public Health. 2019 Jul 20;16(14):2592. doi: 10.3390/ijerph16142592.
This study examined urban-rural differences in the association of access to healthcare with self-assessed health and quality of life (QOL) among old adults with chronic diseases (CDs) in China. The data of 5796 older adults (≥60) with self-reported CDs were collected from the Study on Global Ageing and Adult Health in China, including indicators of self-assessed health and QOL and information on access to healthcare. Associations of access to healthcare with self-assessed health and QOL at the 10th, 50th, and 90th conditional quantiles were determined after controlling individual and household factors, showing that urban patients who received healthcare within two weeks gave higher ratings on self-assessed health scores at the 10th and 50th quantiles. In rural areas, one-year and two-week access to healthcare was found to be associated with QOL scores at the 10th and 90th quantiles, respectively. Marginal effects of using needed health service decreased with a growth in QOL and self-assessed health scores in both urban and rural locations despite these effects being significant across the whole distribution. Overall, access to healthcare affects the self-assessed health and QOL of the elderly with CDs in China, especially in patients with poor health, though differently for urban and rural patients. Policy actions targeted at vulnerable and rural populations should give priority to reducing barriers to seeking health services.
本研究考察了中国城乡老年人慢性病患者（CDs）获得医疗保健服务与自感健康和生活质量（QOL）之间的关联存在差异。本研究的数据来自中国全球老龄化和成人健康研究，包含了 5796 名年龄在 60 岁及以上、自我报告患有 CDs 的老年人的指标，包括自感健康和 QOL 以及获取医疗保健服务的信息。在控制了个体和家庭因素后，确定了医疗保健服务获取与自感健康和 QOL 的第 10、50 和 90 个条件分位数之间的关联，结果显示，在两周内接受过医疗保健服务的城市患者在第 10 和第 50 分位数的自感健康评分更高。在农村地区，一年和两周的医疗保健服务获取与第 10 和第 90 分位数的 QOL 评分分别相关。尽管在整个分布中这些影响都很显著，但在城乡地区，使用所需医疗服务的边际效应随着 QOL 和自感健康评分的增长而降低。总体而言，在中国，获得医疗保健服务会影响患有 CDs 的老年人的自感健康和 QOL，尤其是在健康状况较差的患者中，但城乡患者的影响方式不同。针对弱势群体和农村人口的政策行动应优先考虑减少寻求医疗服务的障碍。
