健康冲击与预防行为变化：来自中国健康与养老追踪调查的证据。
Health shocks and changes in preventive behaviors: Results from the China Health and Retirement Longitudinal Study.
机构信息
School of Public Health, Fudan University, Shanghai, China.
出版信息
Front Public Health. 2022 Jul 27;10:954700. doi: 10.3389/fpubh.2022.954700. eCollection 2022.
BACKGROUND
China is facing the challenge of rising prevalence and ballooning burden of chronic non-communicable diseases (NCDs); however, the Chinese middle- and older-aged population considerably lack preventive behaviors. Health shocks (HS), widely defined as sudden health deterioration brought on by diseases or accidents, bring a "teachable moment" to motivate changes in preventive behaviors.
OBJECTIVE
This study aims to examine the effect of HS on changes in preventive behaviors, including personal health practices and preventive care utilization.
METHODS
HS was defined as any five chronic disease diagnoses (cancer, heart disease, stroke, diabetes, and hypertension). The impacts of HS on smoking, drinking, and exercise, physical examination were estimated. The panel data of 13,705 respondents were obtained from the latest two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. A multilevel propensity score match difference-in-difference (multilevel PSM-DID) model was constructed.
RESULTS
HS significantly decreased smoking (OR = 0.59, < 0.05) and drinking (OR = 0.62, < 0.01) and increased the utilization of auxiliary inspection in physical examination (OR = 1.19, < 0.1). Major HS had significantly considerable and specific effects on reducing smoking and drinking (OR = 0.37 and 0.56, < 0.01), while minor HS had relatively small effects on reducing smoking (OR = 0.74, < 0.05) and drinking (OR = 0.69, < 0.01), but extensive effects on initiating exercise (OR = 1.32, < 0.05), physical examination (OR = 1.18, < 0.1), and auxiliary inspection (OR = 1.30, < 0.05).
CONCLUSION
After HS, there is a teachable moment to promote positive changes in preventive behaviors. Guided by the 5A's brief intervention model (Ask, Advise, Assess, Assist, Arrange), tailored interventions should be targeted at these populations to reduce the risk of the progression and complications of existing diseases, prevent the related comorbidity, and prolong the expected life-span.
背景
中国正面临着慢性病（NCDs）患病率上升和负担增加的挑战；然而，中国中老年人的预防行为却严重不足。健康冲击（HS）被广泛定义为疾病或事故导致的健康恶化，可以带来一个“教育时刻”，促使人们改变预防行为。
目的
本研究旨在检验 HS 对预防行为变化的影响，包括个人健康实践和预防保健利用。
方法
HS 定义为任何五种慢性疾病诊断（癌症、心脏病、中风、糖尿病和高血压）。估计 HS 对吸烟、饮酒和锻炼、体检的影响。使用 2015 年和 2018 年中国健康与退休纵向研究（CHARLS）的最新两波数据，共获得 13705 名受访者的面板数据。构建了多层次倾向评分匹配差分（multilevel PSM-DID）模型。
结果
HS 显著降低了吸烟（OR=0.59，<0.05）和饮酒（OR=0.62，<0.01）的比例，并增加了体检中辅助检查的利用率（OR=1.19，<0.1）。重大 HS 对减少吸烟和饮酒有显著而具体的影响（OR=0.37 和 0.56，<0.01），而轻微 HS 对减少吸烟（OR=0.74，<0.05）和饮酒（OR=0.69，<0.01）的影响相对较小，但对开始锻炼（OR=1.32，<0.05）、体检（OR=1.18，<0.1）和辅助检查（OR=1.30，<0.05）的影响广泛。
结论
HS 后，有一个“教育时刻”可以促进预防行为的积极变化。在 5A 简短干预模型（Ask、Advise、Assess、Assist、Arrange）的指导下，应针对这些人群进行有针对性的干预，以降低现有疾病进展和并发症的风险，预防相关的合并症，并延长预期寿命。
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