School of Public Health, Ningxia Medical University, No. 1160 Shengli Street, Xingqing District, Yinchuan, 750004, Ningxia, China.
Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, China.
Sci Rep. 2024 Jun 8;14(1):13219. doi: 10.1038/s41598-024-64070-z.
The health of women of childbearing age in rural areas is crucial for the development of individuals, families, and society. Research on the identification and influencing factors of health vulnerability in impoverished and disadvantaged groups is important for adjusting and implementing health poverty alleviation policies. However, there is limited research on the health vulnerability of women of childbearing age in rural Western China. Based on panel data from the Rural Residents' Family Health Status Survey in 2019 and 2022, the vulnerability to health poverty of women of childbearing age in rural areas was constructed using the three-stage feasible generalized least squares method. Variables from four dimensions-physical capital, financial capital, social capital, and human capital-were included in the sustainable livelihood analysis framework for analysis. The Tobit model was used to analyze the influencing factors of vulnerability to health poverty among women of childbearing age in rural Western China, and the contribution rates of various factors were studied using the Shapley value decomposition method. In 2019 and 2022, under the poverty line standards of $1.90 and $2.15, respectively, the vulnerability to health poverty among rural women of childbearing age exceeded 20%. Tobit regression analysis revealed that the type of drinking water being well water significantly increased the vulnerability to health poverty of rural women of childbearing age (P < 0.05), whereas the separation of housing and kitchen, registered poor households, household loans, annual per capita household income, expenditures on social interactions, educational level, self-assessed health status, respondent age, and the utilization of hospital services significantly reduced the vulnerability to health poverty of rural women of childbearing age (P < 0.05). Shapley's decomposition shows that annual per capita household income, expenditures on social interactions, respondent age, and household loans are the factors contributing most to the vulnerability to health poverty of rural women of childbearing age, while other variables have a smaller contribution rate. The health poverty situation of women of childbearing age in rural Western China is not optimistic. Preintervention for health poverty should be strengthened among rural women of childbearing age, early warning mechanisms for the risk of falling back into poverty due to illness should be established, the precise identification of highly vulnerable rural women of childbearing age should be improved, and the medical insurance system for rural women of childbearing age should be enhanced to help improve their current health poverty situation.
农村育龄妇女的健康对于个体、家庭和社会的发展至关重要。研究贫困和弱势群体健康脆弱性的识别和影响因素，对于调整和实施健康扶贫政策具有重要意义。然而，目前关于中国西部农村育龄妇女健康脆弱性的研究还很有限。本研究基于 2019 年和 2022 年农村居民家庭健康状况调查的面板数据，采用三阶段可行广义最小二乘法构建了农村育龄妇女健康贫困脆弱性指标，并纳入物理资本、金融资本、社会资本和人力资本四个维度的可持续生计分析框架进行分析。采用 Tobit 模型分析中国西部农村育龄妇女健康贫困脆弱性的影响因素，并采用 Shapley 值分解方法研究各因素的贡献率。在 2019 年和 2022 年，按照分别为 1.90 美元和 2.15 美元的贫困线标准，农村育龄妇女健康贫困脆弱性均超过 20%。Tobit 回归分析表明，饮用水为井水的类型显著增加了农村育龄妇女健康贫困脆弱性（P<0.05），而住房与厨房分离、建档立卡贫困户、家庭贷款、家庭人均年收入、社会交往支出、教育水平、自评健康状况、调查对象年龄、医院服务利用显著降低了农村育龄妇女健康贫困脆弱性（P<0.05）。Shapley 分解表明，家庭人均年收入、社会交往支出、调查对象年龄和家庭贷款是导致农村育龄妇女健康贫困脆弱性的主要因素，而其他变量的贡献率较小。中国西部农村育龄妇女的健康贫困状况不容乐观。应加强对农村育龄妇女的健康贫困前干预，建立因病返贫风险预警机制，提高高度脆弱农村育龄妇女的精准识别，增强农村育龄妇女的医疗保险制度，以帮助改善其当前的健康贫困状况。
