医疗卫生服务利用在儿童期逆境对中老年健康影响间的中介效应

doi:10.12114/j.issn.1007-9572.2020.00.268

摘要/Abstract

摘要： 背景　《“健康中国2030”规划纲要》指出，要覆盖全生命周期，实现从胎儿到生命终点的全程健康服务和健康保障，全面维护人民健康。这意味着必须注重生命早期经历对健康的长远影响。目的　探讨儿童期逆境对中老年健康状况的影响机制，分析医疗卫生服务利用的中介作用。方法　基于CHARLS 2014生命历程调查问卷，CHARLS 2015家户问卷数据，“流调用抑郁量表”简表（CES-D 10量表），利用二元Logistic回归模型和KHB分解的方法对儿童期逆境与中老年健康状况间的关系进行分析。结果　本研究纳入样本人群共计18 587例，其中13 289例（71.50%）中老年人认为自己身体不健康，12 096例（65.08%）未能积极参与生活，5 810例（31.26%）心理健康状况为不健康，12 337例（66.37%）在儿童时期经历过至少一种不良经历，12 319例（66.28%）在儿童期具有较低的社会经济地位，4 015例（21.60%）在儿童期缺乏医疗护理。Logistic回归结果显示，儿童期健康是中老年人自评健康和心理健康的影响因素（P<0.05）；性别、年龄、儿童期社会经济地位、儿童期不良经历、儿童期医疗护理缺乏是中老年人自评健康、心理健康及积极参与生活的影响因素（P<0.05）。中介效应分析显示，医疗卫生服务利用在儿童期社会经济地位、儿童期医疗护理缺乏与中老年自评健康状况间的中介效应分别为5.84%和5.34%，医疗卫生服务利用在儿童期社会经济地位、儿童期医疗护理缺乏与中老年心理健康关系间的中介效应分别为8.74%和5.25%，医疗卫生服务利用在儿童期社会经济地位、儿童期医疗护理缺乏与中老年积极参与生活关系间的中介效应分别为5.54%和5.98%。结论　儿童期社会经济地位和儿童期医疗护理缺乏通过影响中老年时期的医疗卫生服务利用间接影响个体的健康状况。

关键词: 儿童期逆境, 中老年健康状况, 医疗卫生服务利用

Abstract: Background　The Outline of Healthy China 2030 points out that it is necessary to cover the entire life cycle realizing the full range of health services and guarantees from the cradle to the grave and comprehensively safeguard people's health，which means the long-term effects of early life experiences on health should be emphasized. Objective　To explore the influence mechanism of childhood adversity on the health status of middle-aged and elderly people，and to analyze the mediating effect of medical and health services utilization. Methods　Data were drawn from China Health and Retirement Longitudinal Survey 2014—2015 based on CHARLS Life History Questionnaire 2014 and CHARLS Baseline Questionnaire 2015，and Center for Epidemiologic Studies Depression Scale（CES-D 10 Scale）. The binary Logistic regression model and KHB method were used to analyze the association between childhood adversity and middle-aged and elderly health. Results　A total of 18 587 cases were included in the sample population，of which 13 289（71.50%） cases considered themselves unhealthy；12 096（65.08%） cases failed to actively participate in life；5 810（31.26%） cases had unhealthy mental conditions；12 337（66.37%） cases experienced at least one adverse experience in childhood；12 319（66.28%） cases had lower social and economic status in childhood，and 4 015（21.60%） cases lacked medical care in childhood. The results of Logistic regression showed that childhood health was the influencing factor of self-rated health and mental health of middle-aged and elderly people（P<0.05）. Gender，age，social and economic status in childhood，adverse experience in childhood，and lack of medical care in childhood were the influencing factors of self-rated health，mental health and active participation in life of middle-aged and elderly people（P<0.05）.The analysis of mediating effect showed that the mediating effect of medical and health services utilization on the association between social and economic status in childhood，the lack of childhood medical care and the self-rated health of middle-aged and elderly people was 5.84% and 5.34%，respectively. The mediating effect of medical and health services utilization on the association between social and economic status in childhood，the lack of childhood medical care and the mental health of middle-aged and elderly people was 8.74% and 5.25%，respectively. The mediating effect of medical and health services utilization on the association between social and economic status in childhood，the lack of childhood medical care and active participation in life of middle-aged and elderly people was 5.54% and 5.98%，respectively. Conclusion　The social and economic status in childhood and the lack of childhood medical care show the indirect effect on the health of middle-aged and elderly people through affecting medical and health services utilization.

Key words: Childhood adversity, Health outcomes of middle-aged and elderly individuals, Medical and health services utilization

冯桂平,蒋廷凯. 医疗卫生服务利用在儿童期逆境对中老年健康影响间的中介效应[J]. 中国全科医学, 2020, 23(31): 3959-3964. DOI: 10.12114/j.issn.1007-9572.2020.00.268.
FENG Guiping,JIANG Tingkai. The Mediating Effect of Health Services Utilization on the Association between Childhood Adversity and Middle-aged and Elderly Health　[J]. Chinese General Practice, 2020, 23(31): 3959-3964. DOI: 10.12114/j.issn.1007-9572.2020.00.268.

参考文献

［1］张小宁，陈爽，孟坤，等．儿童期社会经济地位与中老年健康的关系研究［J］．中国全科医学，2019，22（7）：849-854．DOI：10.12114/j.issn.1007-9572.2019.00.012.
ZHANG X N，CHEN S，MENG K，et al．Association of childhood socioeconomic status with health in middle-old age［J］．Chinese General Practice，2019，22（7）：849-854．DOI：10.12114/j.issn.1007-9572.2019.00.012.
［2］SCHICKEDANZ A B，ESCARCE J J，HALFON N，et al．Greater exposure to adverse childhood experiences is associated with higher household out-of-pocket medical costs and financial burden in adulthood［J］．American Journal of Preventive Medicine，2019，5：698-707.
［3］BELLIS M，HUGHES K，HARDCASTLE K，et al．The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study［J］．Journal of Health Services Research & Policy，2017，22（3）：168-177．DOI：10.1177/1355819617706720.
［4］CHARTIER M J，WALKER J R，NAIMARK B．Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization［J］．Child Abuse and Neglect，2010，34（6）：454-464．DOI：10.1016/j.chiabu.2009.09.020.
［5］DOOM J R，MASON S M，SUGLIA S F，et al．Pathways between childhood/adolescent adversity，adolescent socioeconomic status，and long-term cardiovascular disease risk in young adulthood［J］．Social Science & Medicine，2017（188）：166-175．DOI：10.1016/j.socscimed.2017.06.044.
［6］中国健康与养老追踪调查［EB/OL］．（2017-05-31）［2019-09-23］．http://charls.pku.edu.cn/zh-CN/page/data/2015-charls-wave4.
［7］TIAN F，MENG S S，QIU P．Childhood adversities and mid-late depressive symptoms over the life course：evidence from the China health and retirement longitudinal study［J］．Journal of Affective Disorders，2019，245：668-678．DOI：10.1016/j.jad.2018.11.028.
［8］LIU H，BYLES J E，XU X，et al．Evaluation of successful aging among older people in China：results from China health and retirement longitudinal study［J］．Geriatrics & Gerontology International，2016，17（8）：1183-1190．DOI：10.1111/ggi.12848.
［9］申淑芳.石家庄市0~6岁儿童生长发育与社会经济地位的关系研究［D］．石家庄：河北医科大学，2015.
［10］沈卓卿．论社会经济地位对儿童学业发展的影响［J］．教育研究，2014，36（4）：70-75.
SHEN Z Q．On the influence of socioeconomic status on children's academic development［J］．Educational Research，2014，36（4）：70-75.
［11］王艳荣，林萍珍，曹枫林．中文儿童期不良经历问卷修订版的效度与信度［J］．中国心理卫生杂志，2018，32（9）：760-764．DOI：10.3969/j.issn.1000-6729.2018.09.010.
WANG Y R，LIN P Z，CAO F L．Validity and reliability of the Chinese version of the Revised Adverse Childhood Experience Questionnaire［J］．Chinese Mental Health Journal，2018，32（9）：760-764．DOI：10.3969/j.issn.1000-6729.2018.09.010.
［12］FINKELHOR D，SHATTUCK A，TURNER H，et al．A revised inventory of adverse childhood experiences［J］．Child Abuse & Neglect，2015，48：13-21．DOI：10.1016/j.chiabu.2015.07.011.
［13］KARLSON K B，BAREEN H R．Comparing regression coefficients between same-sample nested models using logit and probit: a new method［J］．Sociological Methodology，2012，42：286-313．DOI：10.2307/23409353.
［14］聂珺妍，喻红辉，王智强，等．儿童期不良经历与成年后慢性病的相关性研究［J］．中华流行病学杂志，2015，36（9）：953-957．DOI：10.3760/cma.j.issn.0254-6450.2015.09.010．
NIE J Y，YU H H，WANG Z Q，et al．Association between adverse experiences in childhood and risk of chronic diseases in adulthood［J］．Chin J Epidemiol，2015，36（9）：953-957．DOI：10.3760/cma.j.issn.0254-6450.2015.09.010．