基于健康贫困脆弱性视角宁夏回族自治区农村居民卫生服务利用现状及其影响因素分析

Background  In recent yearsthe direction of China's health policy has shifted from poverty alleviation to poverty preventionand rural residents are an important target for poverty prevention in the medical and health fields. Objectives  To understand the current status of health service utilization and its influencing factors among rural residents in Ningxia Hui Autonomous Region under different vulnerabilities of health povertyin order to provide a realistic basis for improving the health service utilization of rural residents and promoting the governance of poverty prevention in the field of medical and health care. Methods  A multistage stratified cluster random sampling method was used to conduct an on-site household survey in four counties of the Ningxia Hui Autonomous RegionHaiyuanYanchiXijiand Pengyang countiesin June-July 2022. A questionnaire was used to collect information on the general demographic characteristics of the rural residentstheir health statushealth service utilizationand household economic situationa three-stage feasible generalized least squaresFGLSwas used to quantify the vulnerability of the residents to health poverty. The three-stage Feasible Generalized Least SquaresFGLS method was used to quantify the vulnerability of residents to health povertyand the rural residents were divided into the vulnerable and non-vulnerable groups with a cut-off value of 0.5. The multifactorial non-conditional logistic regression was used in combination with the Anderson model to analyze the utilization of health services by the rural residents of different vulnerabilities to health poverty and the factors affecting them. Results  A total of 17477 cases of rural residents in Ningxia were included in this studyof which 9154 cases52.4%were male and 8323 cases47.6%were femalethe results of health poverty vulnerability measurement and grouping of the rural residents showed that 29.9%5229 /17477of the residents were vulnerable to health povertyand 70.1%12248/17477of the residents were vulnerable to non-health poverty. The results of health service utilization of rural residents show that the utilization rate of outpatient health services for health poor and vulnerable residents is 3.5%185 /5229and the utilization rate of outpatient services for non-health poor and vulnerable residents is 4.5%556 /12248the residents of different health poor and vulnerable subgroups have different levels of health service utilization in terms of genderageliteracy levelmarital statustype of occupationnumber of permanent residents in the familyhousehold annual incomehospitalization due to illnessself-assessed health statusand other characteristic indicators of outpatient health service utilization were comparedand the difference was statistically significantP<0.05. The results of multifactorial unconditional logistic regression analysis showed that for the health poverty vulnerable residentsthe occupational grouping of otherOR=1.57195%CI=1.084~2.276P=0.017hospitalization due to illnessOR=4.42695%CI=3.193~6.136P<0.001and self-assessed health status grouping of fairOR=11.49995%CI=1.549~85.390P=0.017and poorOR=13.25695%CI=1.760~99.823P=0.012were the facilitators of outpatient health service utilization among rural residentsand literacy level of high school and aboveOR=0.25695%CI=0.073 ~0.902P=0.034and household size 6 personsOR=0.26495%CI=0.074~0.947P=0.041were inhibitors of outpatient health service utilization for rural residentsfor the non-healthy poor vulnerable residentsfemalesOR=1.28295%CI=1.063~1.547P=0.009age subgroups of 36 to 55 yearsOR=1.68995%CI=1.043 to 2.736P=0.033and 56 to 75 yearsOR=1.76395%CI=1.063 to 2.926P=0.028and marital status of being in a marriageOR=2.68295%CI=1.464 to 4.915P= 0.001marital status as divorcedwidowed or otherOR=2.78295%CI=1.412~5.481P=0.003hospitalized due to illnessOR=2.45895%CI=2.019~2.992P<0.001and self-assessed health status as fairOR=3.55595%CI=2.165~ 5.836P<0.001and poorOR=5.47395%CI=3.274~9.151P<0.001were the facilitators of outpatient health service utilization among rural residentsand the number of permanent household members was 2-3OR=0.57895%CI=0.373~0.895P=0.0144-5OR= 0.44195%CI=0.274~0.710P=0.001and 6 personsOR=0.35795%CI=0.209~0.609P<0.001were the inhibitors of residents' outpatient health service utilization. Demand factors among the three dimensions of Anderson's model had the most significant impact on health service utilization among rural residentsand propensity characteristics and enabling resources also had a significant impact. Conclusion  Rural residents of the Ningxia Hui Autonomous Region currently have high health poverty vulnerability and low utilization of outpatient health servicesand there is an urgent need for comprehensive measures to prospectively intervene in the health poverty vulnerability of the populationimprove the primary health care systemand increase the level of utilization of outpatient health services by rural residents.