Study On The Evaluation Of Sub-Health Status And Influencing Factors Of Urban Middle-Aged And Elderly People From The Perspective Of Health Ecology

BackgroundThe concept of sub-health reflects people’s deep thinking about the connotation of health,which itself is a new health thinking focusing on pre-disease prevention.The early identification and prevention of sub-health states can achieve the forward shift of disease prevention and treatment,especially for chronic diseases,thereby better promoting and ensuring the health of the population.Objectives1.to investigate the sub-health status of urban middle-aged and elderly people,including scores and detection rates of sub-health status.2.to explore the factors influencing the sub-health status of urban middle-aged and elderly people from the perspective of health ecology.3.to further examine the association between internal factors,external factors,and sub-health status.MethodsBy multistage stratified random sampling method,a questionnaire based on SHMS V1.0 was used to investigate the sub-health status of 3424 middle-aged and elderly people in five provinces and municipalities of China.Epidata 3.0 was applied for data recording and checking.SPSS 24.0 and AMOS 23.0 were applied for statistical analysis.Independent sample t-test and chi-square test were used for multiple group comparisons.Logistic regression was used to analyze the influencing factors of sub-health status.Structural equation modeling was used to analyze the influence of internal and external factors on sub-health status.Bootstrap technology was used to test the significance of mediating effects.Results1.The reliability and validity analysis indicated that the Cronbach’s α coefficient of SHMS V1.0 was 0.925,and the split-half reliability coefficient was greater than 0.825.The correlation coefficients between the scale items and their corresponding dimensions were the highest,and all of them were greater than 0.603.The exploratory factor analysis extracted a total of 9 common factors,and the cumulative variance contribution rate reached 65.805%.In the confirmatory factor analysis,the model fitted well with CMIN/DF=6.947,GFI=0.935,NFI=0.934,TLI=0.937,CFI=0.943,RMSEA=0.042,and the standardized path coefficients ranged from 0.43 to 0.95.2.According to the SHMS V1.0 scores,the physical,mental,social subscale and total scale conversion scores were(68.94±13.08),(67.75±14.70),(62.05±15.83)and(66.76±12.15),respectively;the physical,mental,social and overall sub-health detection rates were 67.46%,63.84%,69.36%and 66.18%,respectively.3.Univariate and multivariate analyses revealed that age,ethnic group,frustration quotient,personality,health concern,alcohol consumption,smoking,influence of secondhand smoke,sleeping time,whether to go to bed early,breakfast habits,physical exercise,leisure effect,time spent on the Internet,marital status,whether to be an only child,family structure,hobbies and interests,relationship with parents during the growth period,monthly per capita household income,living environment circumstances,work situations,psychological trauma life,stressful events,and medical policies are the influencing factors of sub-health status.4.The analysis of mediating effects showed that the structural equation model fitted well with CMIN/DF=5.563,GFI=0.965,NFI=0.899,TLI=0.900,CFI=0.915,and RMSEA=0.037.The total effect and direct effect of external factors on sub-health were-0.658 and-0.270;the indirect effect of external factors through internal factors on sub-health was-0.387,and the mediating effect accounted for 58.81%.Conclusions1.The SHMS V1.0 scale has good item discrimination,reliability and validity,and can be used as an evaluation tool for the sub-health status of urban middle-aged and elderly people.2.The detection rates of different dimensions of sub-health status of urban middle-aged and elderly people were high,especially the social sub-health status.3.The factors influencing the sub-health status of urban middle-aged and elderly people involve personal traits,behavioral characteristics,interpersonal networks,work and living conditions,and macro policy environment.4.Internal factors play a mediating role between external factors and sub-health status,and paying attention to internal factors such as individual health awareness can more effectively prevent the occurrence of sub-health status.