Abstract: Background　Compared with middle-income and high-income people，low-income people are in a disadvantaged position in access to economic and social resources.According to An Analysis Report of National Health Services Survey in China，2013，the health status of low-income people is significantly lower than the national level，and health problems have become an important issue that plagues them.Objective　To understand the health status and utilization of health services in low-income people，providing recommendations for the achievement of universal health coverage.Methods　 The multi-stage stratified cluster random sampling method was used to select the permanent residents of Xishan District，Wuxi City，Pizhou District，Changzhou City，Wujin District，Suzhou City，Gusu District，Huai'an City，Jinhu County，Zhenjiang City and Yangzhong City as the research objects from September to October 2018.The data of the Jiangsu part of The Sixth National Health Services Survey in China were used for analysis.The surveyed population in Jiangsu was grouped by the internationally used household income five-point method:lowest，second，third，fourth and highest fifth household income quintiles.In this study，the former，the three intermediates，and the latter quintiles were defined as low-，middle- and high income groups，respectively.EQ-5D and VAS were used to measure the health status.Disease prevalence，treatment and hospitalization data were analyzed to explore health service needs and utilization.And multivariate Logistic regression analysis was used to analyze the influencing factors of health service utilization.Results　The low-income group showed higher prevalence of self-evaluated health problems assessed by the EQ-5D and lower mean self-rated VAS scores compared with other two groups（P<0.05）.The middle-income group showed higher prevalence of self-evaluated health problems assessed by the self-care，and pain/discomfort dimensions of the EQ-5D，and lower mean self-rated VAS scores compared with the high-income group（P<0.05）.The rate of two-week illness- induced bedridden in low-income group was higher than that of other two groups（P<0.05）.The rate of two-week temporary absence from work/school due to illness in middle-income group was higher than that of high-income group（P<0.05）.Low-income group showed higher prevalence of self-perceived serious disease than middle-income group and high-income group （P<0.05）.The two-week visit rate in the low-income group was higher than that in the middle-income group（P<0.05）.The percentages of seeking healthcare in medical institutions in low-income group was higher than those of middle-income group，the percentages of following their doctors' advice was lower than those of other two groups（P<0.05）.The percentages of seeking healthcare in medical institutions and following their doctors' advice was higher than those of other two groups（P<0.05）.The percentages of seeking healthcare in primary medical institutions was higher than those of other two groups，and the percentages of seeking healthcare in county/district-level hospitals was lower than middle-income group，and the percentages of seeking healthcare in municipal/provincial hospitals was lower than high-income group（P<0.05）.The percentages of seeking healthcare in primary medical institutions was higher than high-income group，and the percentages of seeking healthcare in municipal/provincial hospitals was lower than middle-income group（P<0.05）.Multivariate Logistic regression analysis showed that age，marital status and chronic disease were the influencing factors affecting whether to see a doctor（P<0.05）.The age and urban-rural were the influencing factors affecting whether to seek healthcare in primary medical institutions in the low-income group（P<0.05）.Conclusion　The health status of low-income people is generally poor，and the gap between health service needs and utilization is obvious.Rural low-income people aged 45-64 are more likely to use health care services when they are suffering from a chronic disease.

Key words: Poverty, Low-income population, Health status, Health service needs and utilization, Root cause analysis

摘要： 背景　相比较中高收入人群而言，低收入群处于经济与社会资源获取的劣势地位。《2013年国家卫生服务调查分析报告》显示，低收入人群的健康状况明显低于全国水平，健康问题成为困扰低收入人群的重要问题。目的　了解低收入人群健康状况及卫生服务利用情况，为有效实现全民健康覆盖提出建议。方法　2018年9—10月采用多阶段分层整群随机抽样法选取江苏省无锡市锡山区、徐州市邳州区、常州市武进区、苏州市姑苏区、淮安市金湖县、镇江市扬中市的常住人口为研究对象，采用国际惯用的收入五分法对研究对象进行分组，将总人数平均分成五组，分别为最低收入组、中低收入组、中等收入组、中高收入组和最高收入组，本次研究将最低收入组纳入低收入组，最高收入组纳入高收入组，其余纳入中等收入组。使用欧洲五维度健康量表（EQ-5D）、视觉模拟评分法（VAS）评分来 测量低收入人群的健康状况，使用患病率、就诊及住院情况来反映其卫生服务需要和利用情况，采用多因素Logistic回归分析探讨其卫生服务利用影响因素。结果　低收入组EQ-5D各维度自评有健康问题的比例均高于中等收入组及高收入组，VAS自评得分均低于中等收入 组及高收入组（P<0.05）。中等收入组自我照顾、疼痛/不适维度中自评有健康问题的比例高于高收入组，VAS自评得分低于高收入组（P<0.05）。低收入组两周患病卧床率均高于中等收入组及高收入组（P<0.05），中等收入组两周患病休工/休学率高于高收入组（P<0.05）。低收入组中患者自感疾病严重比例均高于中等收入组及高收入组（P<0.05）。低收入组两周就诊率高于中等收入组（P<0.05）。低收入组患者到医疗机构就诊比例高于中等收入组，遵医嘱治疗比例均低于中等收入组及高收入组，未治疗比例低于高收入组（P<0.05）；中等收入组患者到医疗机构就诊、遵医嘱治疗比例高于中等收入组（P<0.05）。低收入组就诊者到基层医疗机构就诊比例均高于中等收入组及高收入组，到县、区属医院就诊比例低于中等收入组，到市级、省属医院就诊比例低于高收入组（P<0.05）；中等收入组就诊 者到基层医疗机构就诊比例高于高收入人群，到市级、省属医院就诊比例低于高收入人群（P<0.05）。多因素Logistic回归分析结果显示，年龄、婚姻状况及是否患慢性病是影响其是否就诊的影响因素（P<0.05），年龄及城乡是影响其是否到基层卫生机构就诊的影响因素（P<0.05）。结论　低收入人群健康状况总体较差，卫生服务需要和利用差距明显。年龄在45~64岁之间、患有慢性病的低收入人群更有可能在罹患疾病时利用医疗卫生服务。

关键词: 贫穷, 低收入人群, 健康状况, 卫生服务需要和利用, 影响因素分析