| Objectives:The aim of this study was to investigate the health status and health services utilization of residents among different genders in Pu Er City of Yunnan Province.And to find out the main influencing factors.To evaluate the health equity and health service utilization equity of the whole residents and the residents of different genders,and to explore the main contributing factors of the unequity.So as to provide a theoretical basis for the health equity improvement,the equity of health service utilization and achieve the goal of national healt in Yunnan residentsMethods:Multistage stratified random sampling method was applied to select sample,and a face-to-face questionnaire survey was conducted among 1291 residents of 403 households aged 16 years and over from Pu Er City in Yunnan province.Residents' health status and utilization of health service was described by composition ratio or rate.Chi-square test was used as a method of univariate analysis.Multivariate logistic regression and Zero-inflated model was used to analyze the influcing factors of health condition and health service utilization.Health equity and health services utilization equity were evaluated by the concentration index and Theil index,and the main contributing factors of inequity were explored by the decomposition of the concentration index.Results:The two-week prevalence rate was 15.4%,the average duration of the disease in two weeks was 5.90 days,the average bed time was 0.94 days and the average time off work and school was 1.59 days.The two-week prevalence rate of female(18.7%)was higher than male(12.4%)(P<0.01).The result of multivariate logistic regression showed that female,older age,farmers and chronic diseases were the risk factors of two-week prevalence.The concentration index of the two-week pravalence was-0.1052 and the Horizontal Inequity Index(HI)was-0.0657,which indicated that the two-week prevalence presented poverty inequity no matter the influence of "need variable" was eliminated or not.According to the contribution rate of the two-week prevalence concentration index decomposition,per capita annual income(-219.72%),marital status(31.42%)and age(24.74%)were the main contributing factors to the two-week disease inequity.The increase of per capita economic income will reduce the inequity of two-week poverty,while the increase of marriage,divorce,widowhood and age will strengthen the unfairness of two-week poverty.The two-week prevalence concentration index of male was-0.1526 and that of female was-0.0667,which showed the unequity of poverty,and the extent of male was greater than female.The Theil Index of men was 0.0465 and that of female was 0.0212.The results of the Theil ndex demonstrated that the unfairness of male is greater than female.The prevalence rate of chronic diseases was 13.0%,the average days in bed because of chronic diseases was 34.01,the average days of stopping work and cutting school due to chronic diseases was 8.8 7.Female(15.2%)had a higher prevalence of chronic diseases than male(11.0%)(P<0.01).The results of multivariate logistic regression showed that female,older age and lower per capita annual income were the risk factors of chronic diseases.The concentration index of chronic diseases prevalence was-0.1118 and the Horizontal Inequity Index is-0.1655,which indicatd that the chronic diseases inclined to poverty unfairly no matter the influence of "require variable" was eliminated or not.According to the contribution rate of Concentration Index decomposition of chronic diseases.per capita economic income(-164.91%),age(-60.86%)and marital status(-20.72%)were the main contributing factors to the inequity of chronic diseases prevalence.The increase of per capita economic income and age,and the people who was married,divorced or widowed can strengthen the inequity of poverty.The concentration index of chronic diseases in male was-0.1129 and the concentration index of chronic diseases in women is-0.1078,all of which showed the inequity of poverty,and the inequity degree of male was greater than female.The Theil index of male chronic diseases was 0.0456 and that of female was 0.0262.The results of the Theil index showed that the degree of unfairness of male was greater than female.The demand hospitalization rate was 11.0%and the average hospital day was 12.89 days,which was higher than the fifth national health service survey(11.60).Medical institution were selected at or above the county level,accounting for 51.4%and 41.8%respectively.There was no significant difference in the rate of hospitalization between male(10.0%)and female(12.1%).Multivariate logistic regression presented that in marrige,divorce or widowhood and chronic diseases were the risk factors of hospitalization rate.The main contributing factors of inequity were two-week prevalence(94.58%),nationality(39.89%)and marital status(33.59%)in the light of contribution rate of hospital concentration index decomposition.The concentration index of male and female should be hospitalized is-0.0439,indicating that the degree of inequity between different genders were same,however,the Taier index of male should be hospitalized was 0.0587 and the Taier index of female was 0.0205,indicating that the degree of inequity fom male was greater than that of women.The two-week prevalence rate of patients was 78.9%and the top five reasons why non seeking medical serbices were self medication(31.7%),mild illness(24.4%),economic difficulties(14.6%),loss of confidence(9.8%)and lack of time(9.8%).There was no statistical difference of the two-week prevalence rate between male(77.1%)and female(80.2%)(P>0.05).The results of multivariate logistic regression illustrated that non-farmers and Han nationality were the risk factors of two-week prevalence.The concentration index of two-week hospital visit was-0.04823 and the Horizontal Inequity Index was-0.0452,which indicated that the two-week hospital visit was poor and unfair,and the elimination of "requiire variable" was still poor and unfair.The main contributing factors of unfair treatment for two-week seeking medical advice were per capita income(-110.35%),nationality(20.24%)and age(4.63%).The concentration index of two-week treatment was-0.02108 in male and-0.06952 in female.The inequity of two-week treatment was more obvious in female.The hospital visit rate of patients with chronic diseases was 82.7%,and the top five reasons why the people with chronic diseases didn't visit hospital were economic difficulties(34.4%),mild diseases(34.4%),self buying drugs(6.3%),loss of confidence(6.3%),and inconvenient transportation(3.1%).There was no significant difference of chronic disease visit rate between the male(77.0%)and female(87.2%)(P>0.05),However,the male's prevalence of chronic diseases in the divorced and widowed group(37.5%)wree lower than female(95.0%)(P<0.01).The concentration index of treatment for chronic diseaseswas 0.01948,which indicated that the people with higher income were more concentrated in the treatment of chronic diseases.The concentration index of chronic diseases was 0.02750 for male and 0.01427 for female.The inequity of chronic diseases in male was more obvious than female.The people should be in hospital rate of the respondents was 97.9%.There was no significant difference between male inpatient rate(98.5%)and female inpatient rate(97.3%).The concentration index of inpatients was 0.00532,in which the male was-0.01108,the female was 0.02192,the male was poor and unfair,the female was rich and unfair,the inequity degree among the female was more obvious than the maleConclusions:1.The two-week prevalence rate,chronic disease prevalence rate and hospitalization rate of the research target were lower than the national average level and most coastal developed provinces and cities.The reasons may be related to the level of medical and economic development,residents' health awareness,and the calculation caliber of indicators.The health status of male was better than female when comparing male and female2.Female,older age,farmers and chronic diseases were the risk factors of two-week prevalence.Female,older age and lower income were the risk factors of chronic diseases.Marriage,divorce or widowhood,chronic disease were risk factors for a people who should be in hospital.For high-risk groups,we should strengthen the publicity of health knowledge,broaden the publicity methods,promote target population to improve the behavior of high-risk factors,improve their ability of self-health management and conduct regular physical examination.3.The two-week prevalence,chronic disease and hospitalization conditions of the respondents showed a unfair phenomenon.The results of concentration index and Theil index were close to 0,and the degree of unfairness was low.The inequity in male is greater than female.We should pay more attention to the health service demands of low-income male.4.The two-week prevalence rate of the study objects was lower than the national average and most of the eastern provinces and cities.The hospitalization rate of the respondents was higher than the national average.The reason may be related to the popularity of medical insurance.There was no statistical difference in the utilization of health services between different genders.5.Non-farmer and Han nationality were the risk factors of two-week seeking medical advice rate.The rate of male patients with chronic diseases in divorced and widowed group was lower than in female patients,which may be related to female's gender function.6.The two-week visit outpatients presented a phenononne of unfair poverty.The situation of chronic disease patients and those who should be hospitalized was unequity and the degree of unequity is low. |
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