中国居民2012 — 2017年慢性病防治素养水平变化趋势及其影响因素年龄–时期–队列分析

姜雯; 张蓝超; 李伟豪; 常春; 纪颖; 李英华

doi:10.11847/zgggws1134861

中国居民2012 — 2017年慢性病防治素养水平变化趋势及其影响因素年龄–时期–队列分析

Changing trend in health literacy about chronic disease prevention and treatment among Chinese residents, 2012 – 2017: an age-period-cohort analysis

摘要

摘要:
目的了解中国居民2012 — 2017年慢性病防治素养（慢病素养）水平变化趋势及影响因素，为进一步提高居民慢病素养提供参考依据。
方法采用单纯随机抽样方法在2012 — 2017年全国居民健康素养监测数据库中抽取89153名居民作为研究对象并收集相关数据，采用层次年龄 – 时期 – 队列（APC）法构建多水平固定效应模型分析中国居民慢病素养水平变化趋势及其影响因素。
结果中国居民2012、2013、2014、2015、2016和2017年慢病素养持有率分别为8.52 %、11.01 %、9.01 %、10.05 %、10.25 %和13.96 %，中国居民慢病素养持有率总体呈上升趋势（χ²_趋势 = 118.69，P < 0.001）；居民慢病素养水平时期净效应与时期粗效应的变化大体趋势一致，均表现为2012 — 2016年上下波动，2016 — 2017年快速增长。在控制了人口学变量和健康情况影响后，多水平固定效应模型分析结果显示，文化程度小学及以上、医务人员、自觉健康状况比较好的中国居民慢病素养水平较高，少数民族、农民、工人、中部地区、西部地区和居住在农村的中国居民慢病素养水平较低；将每一年的慢病素养水平与前一年相比，慢病素养水平在2013年、2015年和2017年均较前一年有所上升（OR = 1.200、1.116、1.535，均P < 0.01）。居民慢病素养水平的变化具有明显的时期效应，但中国居民2012 — 2017年慢病素养水平变化未见显著的年龄效应和队列效应（均P > 0.05）。
结论中国居民2012 — 2017年慢病素养水平的时期净效应呈现总体增长趋势，以2016 — 2017年增长速度最快，由政策或健康促进项目带来的时期效应和一些人口学因素对慢病素养水平变化的影响值得重视。

Abstract:
Objective To analyze changing trend and in health literacy about chronic disease prevention (HLCDP) and its associated factors among 15 – 69 years old residents in China from 2012 to 2017 for providing references to the promotion of HLCDP in the population.
Methods Using simple random sampling, we extracted the data on 89 153 urban and rural residents aged 15 – 69 years from the dataset of National Health Literacy Surveillance conducted yearly from 2012 to 2017 across China. A multi-level fixed effect model was constructed using hierarcal age-period-cohort (APC) method to explore changing trend in HLCDP and its associates.
Results For the years from 2012 to 2017, the proportion of the residents with HLCDP were 8.52%, 11.01%, 9.01%, 10.05%, 10.25%, and 13.96%, respectively, with an overall upward trend (χ² = 118.69, P < 0.001). Similar changing trends in net and crude period effect on HLCDP were observed, with a fluctuation from 2012 to 2016 and a rapid increase between 2016 and 2017. After adjusting for demographic factors and health status, the results of multi-level fixed effect model analysis showed that the residents with the education of primary school and above, being medical staff and having a better self-perceived health status were more likely to have a higher HLCDP; while, the residents being ethnic minorities, being farmers or workers, living in central or western regions or in rural areas were more likely to have a lower HLCDP. Significantly increased proportion of the residents having HLCDP were observed in 2013, 2015 and 2017 compared to that in corresponding previous one year, with the odds ratios of 1.200,1.116 and 1.535 (all P < 0.01). The period effect on the variation of HLCDP was significant, but the age-effect or the cohort-effect were not significant (both P > 0.05).
Conclusion Among Chinese residents, the net period effect on HLCDP increased generally from 2012 to 2017 and the effect was greater for the period from 2016 to 2017. Attention should be paid to the impact of period effect and some demographic factors on changing trend of HLCDP.

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