School of Public Health and Management, Ningxia Medical University, Yinchuan, China.
Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, China.
Front Public Health. 2022 Oct 18;10:993977. doi: 10.3389/fpubh.2022.993977. eCollection 2022.
Vulnerability to health-related poverty can predict the probability of families falling into poverty due to health risk impact. In this study, we measured the vulnerability to health-related poverty and examined the mediation path of physical multimorbidity on the vulnerability to health-related poverty of rural aging families in Ningxia, China.
This cross-sectional study was conducted in Ningxia, China, in February 2019. A multi-stage stratified cluster-randomized design was used to obtain a representative sample in each county. We included participants aged 60 years and older, who had lived there for more than 1 year. A total of 3,653 rural residents older than 60 years old were selected as the research subjects. The three-stage generalized least square method was used to calculate the expected vulnerability to poverty. We used mediating effect model to test the mediation path of poverty vulnerability related to the physical multimorbidity.
Under different poverty line standards, i.e., $1.9/day as low vs. $3.1/day as the high poverty line, the proportion of families that could fall into poverty in the future was 5.3 and 53.7%, respectively. The prevalence of chronic diseases and physical multimorbidity among rural residents >60 years old was 64.62 and 21.24%, respectively. The results of mediating effect test showed that self-rated health status (indirect effect a × b = -0.0052), non-agricultural employment (a × b= -0.0046), household cattle production (a × b = 0.0004), housing type (a × b = -0.0008), gift expenses (a × b = 0.0006) and loan for illness (a × b = 0.0034) were the mediation paths of poverty vulnerability related to the physical multimorbidity.
Concerted efforts are needed to reduce poverty vulnerability related to the physical multimorbidity. The strategy of alleviating poverty should emphasis on promoting non-agricultural employment of vulnerable groups sustainability and developing rural economy, which are important paths to reduce family's vulnerability to health-related poverty.
健康相关贫困脆弱性可以预测家庭因健康风险而陷入贫困的概率。本研究旨在测量中国宁夏农村老年家庭的健康相关贫困脆弱性，并探讨身体多病对健康相关贫困脆弱性的中介作用。
本横断面研究于 2019 年 2 月在中国宁夏进行。采用多阶段分层整群随机设计，在每个县获得有代表性的样本。我们纳入了年龄在 60 岁及以上、在当地居住超过 1 年的参与者。共选择了 3653 名 60 岁以上的农村居民作为研究对象。采用三阶广义最小二乘法计算贫困脆弱性的预期值。采用中介效应模型检验与身体多病相关的贫困脆弱性的中介路径。
在不同的贫困线标准下，即每天 1.9 美元的低贫困线与每天 3.1 美元的高贫困线，未来可能陷入贫困的家庭比例分别为 5.3%和 53.7%。60 岁以上农村居民慢性病和身体多病的患病率分别为 64.62%和 21.24%。中介效应检验结果表明，自评健康状况（间接效应 a×b=-0.0052）、非农业就业（a×b=-0.0046）、家庭养牛（a×b=0.0004）、住房类型（a×b=-0.0008）、礼品支出（a×b=0.0006）和因病贷款（a×b=0.0034）是身体多病与贫困脆弱性相关的中介途径。
需要共同努力降低与身体多病相关的贫困脆弱性。缓解贫困的策略应强调促进弱势群体可持续的非农业就业和发展农村经济，这是降低家庭健康相关贫困脆弱性的重要途径。
