| Objectives:The aim of this study was to analyze the prevalence,lifestyle and health service utilization of five common chronic diseases(hypertension,diabetes,coronary heart diseases,stroke and COPD)among older adults in target rural Yunnan Province,and to estimate financial risk of these diseases.This study also examined the influencing factors of numbers of chronic diseases and its financial risk based on SEM and aimed to recognize vulnerable and key populations in order to provide the strategy to improve the management and control of chronic diseases.Methods:This study was a cross-section survey,multi-stage stratified random sampling was used to select the study sample consisted of 4833 older adults aged 60 years and over in rural Yunnan province.Each participant received questionnaire interview and physical examination.Information on demographic characteristic,family economic condition,diagnosis of five chronic diseases,lifestyle factors,health service utilization,health expenditure(hospitalization expenditure,outpatient expenditure,medicine cost,nutrition fee,accommodation and transportation costs)was obtained with questionnaire.Height,weight,waist circumference,BP and FBG were measured.Chi-square test was used to compare categorical variables containing prevalence,associated lifestyle,household with catastrophic expenditure and impoverishment from medical expenses of five chronic diseases among older adults,while t-test or ANOVA was used to compare the financial risk and direct economic burden of chronic diseases.Principle component analysis was used to construct the SEP index.SEM was used to analysis the influencing factors associated with numbers of five chronic diseases and their direct economic burden by AMOS 22.0.Results:1.The prevalence of hypertension,diabetes,coronary heart diseases,stroke,COPD and multi-morbidity was 50.6%,10.2%,5.5%,6.4%,5.4%and 16.1%respectively in older adults in target area of Yunnan province.Females had higher prevalence of hypertension and diabetes than males whereas males had higher prevalence of COPD than females(P<0.05).The prevalence of hypertension,coronary heart diseases,stroke,COPD and multi-morbidity were increased with age growing up(P<0.05).Older adults with poor household assets had higher prevalence of hypertension,coronary heart diseases,stroke,COPD and multi-morbidity than their counterparts(P<0.01).Older adults with poor access to medical service had higher prevalence of hypertension,diabetes,coronary heart diseases,stroke,COPD and multi-morbidity than their counterparts(P<0.01).The prevalence of hypertension,coronary heart diseases,stroke,COPD and multi-morbidity were decreased with SEP raise up(P<0.01).2.The prevalence of smoking,drinking,obesity,central obesity,physical inactivity,sleep disorder,family history of chronic diseases and good SEP were 21.2%,15.2%,6.6%,52.8%,51.1%,46.7%,20.3%and 40%respectively in older adults in target area of Yunnan province.Older adults who had smoked,drunk,obesity,central obesity,physical inactivity,sleep disorder and family history of chronic diseases had higher prevalence of one,two and three numbers of chronic diseases than their counterparts(P<0.05).3.The two-week outpatient visit rate in older adults with five chronic diseases ranged from 22.5%-33.6%,and was highest in COPD patients in older adults in target area of Yunnan province.The two-week without treatment rate in older adults with five chronic diseases ranged from 34.1%-44.7%,and was highest in diabetes patients.The one-year hospitalization rate in older adults with five chronic diseases ranged from 30.8%-48.7%,and was highest in stroke patients.The one-year hospitalization but not to be rate in older adults with five chronic diseases ranged from 3.9%-11.3%,and was highest in coronary heart diseases patients.4.Direct economic burden of hypertension,diabetes,coronary heart diseases,stroke and COPD was 2210.3Yuan,3232.0Yuan,4125.4Yuan,3783.4Yuan and 3483.8Yuan in target area,respectively.CHD,stroke and COPD patients had higher economic risk(RR and ARR)than the observed population.The incidence of household with CHE due to hypertension,diabetes,stroke,COPD,and CHD was 32.7%,38.5%,39.3%,41.4%and 39.7%,respectively before medical insurance reimbursement,whereas the incidence of CHE of these diseases was 26.3%,30.8%,37.1%,37.3%and 35.1%respectively after medical insurance reimbursement.The incidence of household IM due to hypertension,diabetes,stroke,COPD,and CHD was 28.1%,27.7%,35.1%,32.8%and 39.3%,respectively before medical insurance reimbursement,whereas the incidence of IM was 11.3%,15.4%,17.9%,18.0%and 13.7%,respectively after medical insurance reimbursement.5.The results of SEM indicated that family history of chronic diseases,SEP,behaviour factors(smoking and drinking)and gender had both direct and indirect effect on numbers of chronic diseases,and the standardized regression coefficients were 0.25,-0.12,0.22 and 0.02,respectively.Family history of chronic diseases positively effected on numbers of chronic diseases via body composition.Behaviour factors positively effected on numbers of chronic diseases via body composition and physical inactivity together.Gender positively effected on numbers of chronic diseases via body composition,behaviour factors and SEP.SEP negatively effected on numbers of chronic diseases via sleep quality.Otherwise body composition,physical inactivity and sleep quality just had direct effect on numbers of chronic diseases,and the standardized regression coefficients were 0.24,0.08 and-0.09,respectively.Body composition and physical inactivity had positive effect on numbers of chronic diseases,while sleep quality had negative effect on numbers of chronic diseases.Age just had positive indirect effect on numbers of chronic diseases,and the standardized regression coefficients were 0.08.6.The results of SEM indicated that the direct economic burden of hypertension were associated with hospitalization situation,annual outpatient visits and multi-morbidity of chronic diseases,and their standardized regression coefficients were 0.60,0.16 and 0.14,respectively.The direct economic burden of diabetes was associated with hospitalization situation and annual outpatient visits,and their standardized regression coefficients were 0.61 and 0.11.The direct economic burden of coronary heart diseases was associated with hospitalization situation,demographic characteristics and annual outpatient visits,and their standardized regression coefficients were 0.58,0.17 and 0.17,respectively.The direct economic burden of stroke was associated with hospitalization situation,multi-morbidity of chronic diseases and annual outpatient visits,and their standardized regression coefficients were 0.65,-0.21 and 0.23,respectively.The direct economic burden of COPD was associated with hospitalization situation,and its standardized regression coefficients was 0.41.Conclusions:1.The prevalence of hypertension and stroke in target area of rural Yunnan province were higher than other parts of China,whereas the prevalence of diabetes,coronary heart diseases and COPD were lower than other parts of China.The prevalence of five chronic diseases were disparity in different demographic characteristic population.2.The results of SEM indicated that family history of chronic diseases,SEP,behaviour factors and gender had both direct and indirect effect on numbers of chronic diseases,otherwise body composition,physical inactivity and sleep quality just had direct effect on numbers of chronic diseases.Age just had indirect effect on numbers of chronic diseases.Meanwhile,they interacted with each others to build a complex path and network effect on numbers of chronic diseases.Family history of chronic diseases,lifestyle factors,body composition,physical inactivity,age growing up and female were risk factors associated with the prevalence of numbers of chronic diseases,whereas good SEP and sleep quality were the protective factors of numbers of chronic diseases.3.The two-week outpatient visit rate in older adults in target area of rural Yunnan province with five chronic diseases were lower than other studies in China,Meanwhile the two-week without treatment rate were higher than other studies in China,especially in older adults with diabetes.The one-year hospitalization rate in older adults with five chronic diseases were higher than other parts of China,especially in older adults with stroke.The one-year hospitalization but not to be rate in older adults were lower than other studies in China.4.Household with CHD older adults had higher financial risk of disease,and followed by household with stroke patients and COPD patients.Households with older CHD patients,stroke patients and COPD patients were more likely to occur catastrophic health expenditure and impoverishing health expenditures.5.There were disparities between influencing factors of five chronic diseases according to SEM model,but hospitalization situation were the common risk factor of direct economic burden of five chronic diseases.The patient who had longer duration of hospitalization and higher grade of hospital hospitalized had higher direct economic burden. |
PDF Full Text Request