Research Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
School of Public Health, Peking University, Beijing, China.
Int J Equity Health. 2022 Nov 15;21(1):161. doi: 10.1186/s12939-022-01774-6.
Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty.
The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified.
First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors.
The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.
空气污染已被确定与易感人群的疾病有关，但很少有研究调查其经济负担的空间异质性及其决定因素。在新冠肺炎疫情之后，人类面临着健康和环境的双重危机，一些地区容易陷入贫困，这个问题具有重大的政策意义。
采用地理探测器研究中国 100 个农村地区市县级老年灾难性卫生支出（ICHE）的发病空间分布特征。确定健康因素、社会因素、政策因素和环境因素及其相互作用。
首先，大多数卫生服务因素对 ICHE 具有很强的解释力，无论是否与空气污染相互作用。其次，研究发现了 50 个 ICHE 的单因素高风险区，但同时也存在 21 个以多种因素为主导的区域。
各因素之间的不同贡献和协同作用构成了因素和灾难性卫生支出的复杂机制。此外，在这个过程中，空气污染加剧了卫生服务因素对 ICHE 的贡献。此外，ICHE 的主导因素在不同地区有所不同。最后，本文还从后 COVID-19 世界的健康和环境危机角度提出了一些政策建议：应将环境保护政策与传染病预防相结合；对空气污染和冠状病毒病 2019（COVID-19）等传染病的逆向健康序列进行先进的卫生投资是最具成本效益的政策；将环境保护政策纳入健康发展政策，不同地区采取有针对性的措施应对交织在一起的危机。
