Ma Muye, Li Pengfei, Lu Zhengyang, Zhang Nan, Wang Suzhen, Lu Youhua, Yu Jinming
School of Public Health, Shandong Second Medical University, Weifang, Shandong, China.
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China.
Front Oncol. 2025 Jun 12;15:1596332. doi: 10.3389/fonc.2025.1596332. eCollection 2025.
Despite numerous studies on endoscopic services in urban settings, tailored assessments in rural healthcare remain limited, creating a gap in our understanding of resource-constrained environments. To address this gap, this study innovatively applied the Andersen Behavioral Model to systematically quantify endoscopic examination uptake and identify both patient-level (e.g., occupation, health history) and region-level (e.g., infrastructural challenges, socioeconomic indicators) factors influencing service utilization in rural China.
We employed a multi-level logistic regression model with random intercepts to account for intraregional correlation and fixed effects for individual predictors. A multi-stage stratified random sampling approach was employed across 6 prefectures, yielding a sample of 1118 patients. We initially used descriptive statistics to summarize basic sample characteristics. Univariate analysis was then conducted to identify potential factors associated with endoscopic examination utilization. To further quantify these associations, we applied single-level and multi-level logistic regression model to account for potential regional effects and provide more robust analysis.
Of the 1,118 surveyed patients, 62.3% underwent endoscopic examinations, and among these, 77.9% received services at county-level institutions. In single-level binary logistic regression, region, occupation, household size, history of gastritis/esophagitis, and lesion location emerged as significant predictors ( < 0.05). In the multi-level logistic regression model, region remained a key factor, with the western region exhibiting 0.661 times lower odds (95% CI: 0.392-1.115) and the central region revealing 1.398 times higher odds (95% CI: 1.006-1.943) of service utilization compared to the eastern region. Additionally, unemployed status was associated with a 20% increased likelihood, and smaller household size correlated with a 87% increase in screening uptake.
Our findings underscore the importance of addressing regional disparities through targeted resource allocation and localized health education programs to improve endoscopic service uptake among rural populations. These insights can inform policy interventions aimed at early cancer detection and optimized healthcare delivery in resource-limited settings.
尽管针对城市环境中的内镜服务开展了大量研究，但针对农村医疗保健的针对性评估仍然有限，这使得我们对资源受限环境的理解存在差距。为了填补这一差距，本研究创新性地应用安德森行为模型，系统地量化内镜检查的接受情况，并确定影响中国农村地区服务利用的患者层面因素（如职业、健康史）和地区层面因素（如基础设施挑战、社会经济指标）。
我们采用了具有随机截距的多层次逻辑回归模型，以考虑区域内相关性，并对个体预测变量采用固定效应。在6个 prefectures 采用多阶段分层随机抽样方法，获得了1118名患者的样本。我们首先使用描述性统计来总结基本样本特征。然后进行单变量分析，以确定与内镜检查利用相关的潜在因素。为了进一步量化这些关联，我们应用单层次和多层次逻辑回归模型来考虑潜在的区域效应，并提供更稳健的分析。
在1118名接受调查的患者中，62.3% 接受了内镜检查，其中77.9% 在县级机构接受服务。在单层次二元逻辑回归中，地区、职业、家庭规模、胃炎/食管炎病史和病变位置成为显著预测因素（<0.05）。在多层次逻辑回归模型中，地区仍然是一个关键因素，与东部地区相比，西部地区的服务利用几率低0.661倍（95% CI：0.392 - 1.115），中部地区的服务利用几率高1.398倍（95% CI：1.006 - 1.943）。此外，失业状态与可能性增加20% 相关，家庭规模较小与筛查接受率增加87% 相关。
我们的研究结果强调了通过有针对性的资源分配和本地化健康教育计划来解决区域差异，以提高农村人口内镜服务接受率的重要性。这些见解可为旨在早期癌症检测和资源有限环境中优化医疗服务提供的政策干预提供参考。
