Study On The Self-rated Health Status And Influencing Factors Of Middle-aged And Elderly People Aged 40 And Above In Henan Province

ObjectiveTo understand the current situation of the health status of middle-aged and elderly people aged 40 and above in Henan Province,and to explore the change trend of the health status of middle-aged and elderly people in Henan Province before and after the implementation of the new medical reform ten years.To explore whether there is regional aggregation of self-rated health status in middle-aged and elderly people,and to analyze the influencing factors of self-rated health status of middle-aged and elderly people,so as to provide relevant reference basis for realizing healthy aging,moving forward of health gate and allocating health resources rationally.MethodsThe data were collected from the fourth（2008）,the fifth（2013）and sixth（2018）health service surveys of Henan Province,and the sampling method was multi-stage stratified cluster random sampling.Based on the results of the 2010 National Census,the data were standardized to analyze the health status and change trends of the elderly in Henan Province during the ten years of the implementation of the new medical reform.The health status mainly included self-reported chronic diseases,hypertension,diabetes and physical discomfort（poor self-rated health status）.Based on the survey data of 2018,a single factor analysis of the self-rated health status of middle-aged and elderly people was firstly conducted,and then single level and multilevel Logistic regression models were used to analyze the influencing factors of self-rated health status.The residual test of the model hypothesis was carried out.Then,the optimal model was found through goodness of fit test.Finally,the contribution of each variable to self-rated health status was discussed by calculating standardized regression coefficients.Results1.In 2018,the prevalence of chronic diseases among middle-aged and elderly people in Henan Province was 44.72%,and the standardized prevalence rate was39.18%.The detection rate of physical discomfort was 33.73%,and the standardized detection rate was 29.73%.The standardized prevalence rate of chronic diseases increased by 6.05 percentage points compared with 2013 and 9.58 percentage points compared with 2008.The standardized detection rate of physical discomfort increased by 8.18 percentage points compared with 2013 and 12.94 percentage points compared with 2008.The standardized prevalence rate of chronic diseases and the standardized detection rate of physical discomfort in the middle-aged and elderly showed a significant upward trend over time(χ² trend=200.533,P_trend<0.05;χ² trend=448.661,P_trend<0.05,respectively).2.In the three surveys,the prevalence rates of diabetes and the detection rates of physical discomfort in middle-aged and elderly women were higher than those in men（P<0.05）,the prevalence rates of hypertension and diabetes in urban middle-aged and elderly people were higher than those in rural areas（P<0.05）,and the detection rates of physical discomfort in rural middle-aged and elderly people were higher than those in urban areas（P<0.05）.In the fourth and fifth surveys,the prevalence rates of hypertension in middle-aged and elderly women were higher than those in men（P=0.024,P<0.001,respectively）,and the prevalence rates of chronic diseases in urban middle-aged and elderly people were higher than thaose in rural areas（P=0.001,P<0.001,respectively）.However,in the sixth survey,there was no statistically gender difference in the prevalence of hypertension（P=0.067）,and the prevalence of chronic diseases in rural middle-aged and elderly people was higher than that in urban areas（P<0.001）.3.The analysis of the influencing factors of the self-rated health status of middleaged and elderly people showed that there was an aggregation of physical discomfort at the community（village）level（the intraclass correlation coefficient was 0.187）.The random effect model found that the the influence of the signing status of family doctors on the physical discomfort of middle-aged and elderly people was different among different communities（ =0.24,P=0.001）.The cross-layer interaction effect model of urban and rural areas and family doctor contract service was the optimal model in this study,and compared with the single level model,the protective effect of smoking on physical discomfort was no longer statistically significant relative to never smokers（OR=0.917,95%CI: 0.814～1.033）.The standardized regression coefficient of the optimal model showed that,in addition to the objective health status（injury within two weeks,chronic disease,living in hospital within one year）and immutable risk factors（age）,the risk factors of self-rated health status of middle-aged and elderly people contributed the most to being unemployed,followed by rural and uncontracted family doctor services（Reference: urban and contracted family doctor service）.Other risk factors for self-rated health status included retired,low-income households,unmarried/divorced/widowed,underweight,poor households,increased distance from the nearest medical institution,quitting smoking,and obesity.The protective factors of self-rated health included the increase of physical exercise,education level,family per capita annual income,and physical examination within one year.Conclusions1.In the ten years of the new medical reform,the prevalence of self-reported hypertension among middle-aged and elderly people in Henan Province is relatively stable in urban,but the overall self-reported chronic diseases,hypertension,diabetes and physical discomfort in all subgroups（age group,sex and urban-rural distribution）show a significant upward trend over time.In addition,the gender difference of chronic diseases among middle-aged and elderly people is narrowing,and the growth trend of chronic diseases in rural areas is more significant.2.The self-rated health status of middle-aged and elderly people is aggregated in the same community（village）level,and the quality of family doctor signing service may vary in different communities（villages）.In the future,it is necessary to focus on rural areas and improve the signing coverage while ensuring the service quality.At the same time,health management should be strengthened for high-risk groups such as those with poor objective health status,advanced age,and unemployed.