| Objective:Understand HIV/AIDS patients’ health and health service utilization status who received ART,evaluate the health and health service utilization equity,and analyze the influencing factors of the equity,then to provide basis and reference for the formulation of relevant health policies,after that,further improve the equity of the health and health service utilization of HIV/AIDS patients,and promote their health.Methods:This was a cross-sectional study.HIV/AIDS patients receiving ART in designated hospitals and meeting the inclusion and exclusion criteria were selected as the subjects.A total of 921 people were surveyed face to face with a self-designed questionnaire.The measurement data follow normal distribution were described as mean ± standard deviation,t-test was used for comparison between two groups,and ANOVA was used for comparison between multiple groups;The measurement data which does not follow normal distribution were described by M(P2.5,P75),and the rank sum test was used for comparison between groups.Qualitative data was described by n(%),and chi-square test was used for comparison between groups.Influential factors were analyzed by binary Logistic regression analysis and Hurdle model.Equity was evaluated by concentration index,and the contribution of equity was analyzed by concentration index decomposition.Results:1.A total of 921 people were investigated.The respondents’ age was from 16 to 81 years old,with an average age of 38.99±11.24.The proportion of female was 38.2%and that of male was 61.8%.The majority of ethnic groups were Han(82.8%).More than half of the respondents were married(53.2%),followed by unmarried(29.6%)and divorced or widowed(17.2%).The education level of the respondents were low,74.9%of the respondents’ education level were senior high school or below.Except for farmers,public servants in enterprises and public institutions,and freelance occupations,other occupations accounted for 34.3%,freelance occupations accounted for 31.5%.2.The two-week prevalence rate of the respondents was 21.5%.There existed pro-poor inequtiy in two-week prevalence as the Concentration Index(CI)of two-week prevalence was-0.0282,and the Horizontal Inequity Index(HI)was-0.0285.The same signs of the CI and HI showed that after removing the influence of required variables,pro-poor inequity also existed.The required variables had little contribution to the CI as the absolute value of the difference between the CI and HI was small.Income and occupation were the main factors affecting the inequality.3.The rate of chronic disease prevalence of the respondents was 18.6%,and the top three chronic diseases were chronic hepatitis(5.3%),hypertension(3.6%)and chronic gastritis(1.3%).The influencing factors of chronic disease prevalence were gender and age:the rate of chronic disease prevalence in females was lower than that in males;the respondents with older ages had higher chronic desease prevalences.There existed pro-poor inequtiy in chronic disease prevalence as the CI of chronic disease prevalence was-0.0632,and the HI was-0.0961.The same signs of the CI and HI showed that after removing the influence of required variables,pro-poor inequity also existed,and the degree of inequity increased.Gender,educational level,age and income were the main factors affecting the inequality.4.The required hospitalization rate of the respondents was 14.5%.The influencing factors for required hospitalization were education level,marital status and chronic disease:the rate of required hospitalization in secondary vocational schools and senior high schools was lower than that of primary schools and below;the rate of those who were married were higher than those who were divorced and widowed;the rate of those with chronic diseases were higher than those without chronic diseases.There existed pro-poor inequity in required hospitalization as the CI of required hospitalization was-0.0478,and the HI was-0.0625,The same signs of the CI and HI showed that after removing the influence of required variables,pro-poor inequity also existed,and the degree of inequity increased.Income,marital status,gender,education level and age were the main factors affecting the inequality.5.The two-week visiting rate was of the respondents 9.9%.The common influencing factor of two-week visiting and two-week visiting frequency was whether patients had chronic disease or not:the two-week visiting rate and the average visiting number in patients with chronic disease were higher than those without chronic disease.There existed pro-rich inequity in two-week visiting as the CI of two-week visiting was 0.0636,and the HI was 0.0521,The same signs of the CI and HI showed that after removing the influence of required variables,pro-rich inequity also existed,and the degree of inequity reduced.Income,marital status,occupation,age,poverty and education level were the main factors affecting the inequality.6.The visiting rate of chronic disease of the respondents was 9.6%.The influencing factors of chronic disease visiting rate were gender and age:the male visiting rate was higher than female;the respondents with older ages had higher chronic desease visiting rate.There existed pro-poor inequity in the chronic disease visiting as the CI of chronic disease visiting was-0.0405,and the HI was-0.1091.The same signs of the CI and HI showed that after removing the influence of the required variables,pro-poor inequity also existed,and the degree of inequity increased.Income,marital status,gender,education level,poverty,and the number of family members were the main factors affecting the inequality.7.The hospitalization rate of the respondents was 13.5%.The common influencing factor of hospitalization and hospitalization frequency was education level:as education level increased,the probability of hospitalization and the average number of hospitalizations decreased.Marital status was the influencing factor of hospitalization:the rate of hospitalization was higher in married people than in divorced and widowed people.There existed pro-poor inequity in hospitalization as the CI of hospitalization rate was-0.0544,and the HI was-0.0712.The same signs of the CI and HI showed that after removing the influence of required variables,pro-poor inequity also existed,and the degree of inequity increased.Income,gender,marital status and education level were the main factors affecting the inequality.8.The two-week prevalence visiting rate of the respondents was 46.6%.There existed pro-rich inequity in two-week prevalence visiting as the CI of two-week prevalence visiting was 0.0971,and the HI was 0.0798.The same signs of the CI and HI that after removing the influence of the required variables,pro-rich inequity also existed,and the degree of inequity decreased slightly.Income,age,marital status and occupation were the main factors affecting the inequality.The clinics of two-week prevalence visiting were mainly concentrated in provincial hospitals,followed by individual clinics and city-level hospitals.The main reasons for not two-week visiting were buying medicine by oneself(63.1%),mild illness(18.4%)and economic difficulties(9.7%).9.The visiting rate of chronic disease prevalence of the respondents was 51.5%.There existed pro-rich inequity in the visiting for chronic diseases prevalence as the CI of visiting for chronic diseases prevalence was 0.0295,and the HI was 0.0141.The same signs of the CI and HI showed that after removing the influence of the required variables,pro-rich inequity also existed,and the degree of inequity reduced slightly.Income,marital status,age,occupation,education level and ethnicity were the main factors affecting the inequality.The hospitals for chronic diseases visiting were mainly concentrated in city-level hospitals and provincial-level hospitals.The main reasons for not visiting were buying medicine by oneself(35.8%),mild illness(28.4%)and economic difficulties(22.2%).10.The hospitalization rate among the required hospitalized of the respondents was 92.3%.There existed pro-poor inequity in the hospitalization rate among the required hospitalized as the CI of tthe hospitalization rate among the required hospitalized was-0.0084,and the HI was-0.0095,The same signs of the CI and HI showed that after removing the influence of the required variables,pro-poor inequity also existed.The required variables had little contribution to the CI as the absolute value of the difference between the CI and HI was small.Occupation and age were the main factors affecting the inequality.Inpatient institutions were mainly concentrated in city-level hospitals,followed by provincial-level hospitals.The main reasons for not being hospitalized were unnecessary illness(50%)and economic difficulties(40%).Conclusions:1.The health service needs,demands,and utilization equity of HIV/AIDS patients were generally acceptable,but there still existed a certain degree of inequity2.There existed pro-poor inequtiy in two-week prevalence.There existed pro-rich inequity in two-week visiting and two-week prevalence visiting.The degree of inequity of two-week prevalence visiting was the largest,followed by two-week visiting,and the two-week prevalence was the lowest.3.There existed pro-poor inequtiy in chronic disease prevalence and chronic disease visiting.There existed pro-rich inequity in the visiting for chronic diseases prevalence.The degree of inequity of chronic disease prevalence was the largest,followed by chronic disease visiting,and the visiting for chronic diseases prevalence was the lowest.4.There existed pro-poor inequity in required hospitalization,hospitalization and hospitalization rate among the required hospitalized.The degree of inequity of hospitalization was the greatest,followed by required hospitalized,and hospitalization rate among the required hospitalized was the lowest.5.The chronic disease was the common risk factor for two-week visit,the number of two-week visits,required hospitalization,and the number of hospitalizations.More attention should be paid to the patients with chronic diseases,and health management should be strengthened to improve the patients’s quality of life with chronic diseases.6.Income was the primary contributor to inequality,which was consistent with the results of domestic and foreign research.But the influence of education level,gender,marital status,age,occupation and other factors should not be ignored.We should pay more attention to people with low-income groups,divorced and widowed,low education,male,and the elderly. |
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