Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, China.
Front Public Health. 2022 Feb 14;10:776901. doi: 10.3389/fpubh.2022.776901. eCollection 2022.
Health poverty has become the most important cause of poverty and return to poverty. Understanding the health risk factors and action paths of poverty in families of rural elderly with chronic diseases is important to alleviate return to poverty because of illness. This study selected families with at least one elderly member (over 60 years old) with chronic diseases (sample size was 1,852 families) in two provinces and four counties in central and western China. The three-stage feasible generalized least square method was adopted, and the appropriate poverty line standard was selected to measure the poverty vulnerability index. A poverty vulnerability index ≥50% was considered to indicate vulnerability. The poverty vulnerability index and actual income status were combined to classify the samples. A structural equation model was established to explore the path of each health risk factor on the entire sample and various types of poverty vulnerabilities. The mean poverty vulnerability of 1,852 families was 0.5974 ± 0.25213, and among which, 1,170 households had a poverty vulnerability value ≥0.5, accounting for 63.17% of the entire sample. The incidence of poverty was higher among people with low vulnerability to poverty. Health shock was the direct cause of poverty for people with potential and avoidance poverty. The mediating roles of family and community significantly differed in various types of poverty vulnerability. The social and economic environment in rural areas should be enhanced in a diversified manner, and the income-generating ability of rural households should be improved based on actual local conditions. Moreover, the prevention and control of poverty vulnerabilities should be diversified and targeted. Policies implemented should be based on people and localities, the causes of poverty and returning to poverty, and the types of poverty vulnerabilities. The use efficiency of medical insurance should be further improved, and the responsibility of medical insurance targeted poverty alleviation must be clarified.
健康贫困已成为贫困和返贫的最重要原因。了解农村慢性病老年患者家庭的健康风险因素和致贫返贫的行动路径，对于缓解因病致贫返贫具有重要意义。本研究选取了中国中西部两省四县至少有一名 60 岁以上患有慢性病的老年人的家庭（样本量为 1852 户）。采用三阶段可行广义最小二乘法，选择合适的贫困线标准来衡量贫困脆弱性指数。将贫困脆弱性指数≥50%定义为脆弱性。将贫困脆弱性指数和实际收入状况相结合对样本进行分类。建立结构方程模型，探讨整个样本和各种类型贫困脆弱性中每个健康风险因素的路径。1852 户家庭的平均贫困脆弱性为 0.5974±0.25213，其中 1170 户家庭的贫困脆弱性值≥0.5，占整个样本的 63.17%。低脆弱性贫困人口的贫困发生率较高。健康冲击是潜在和避免贫困人群致贫的直接原因。家庭和社区的中介作用在各种类型的贫困脆弱性中存在显著差异。应多途径增强农村地区的社会经济环境，根据实际情况提高农村家庭的创收能力。此外，应多样化和有针对性地预防和控制贫困脆弱性。实施的政策应以人为本、立足地方，以贫困和返贫的原因以及贫困脆弱性的类型为依据。应进一步提高医疗保险的使用效率，并明确医疗保险精准扶贫的责任。
