国家基本公共卫生服务老年人健康体检的异常检出率分析
Elderly use and advice on basic public health check-up programs: Based on a survey of residents in the three provinces of eastern, central and western regions
背景 我国国家基本公共卫生服务为65岁及以上老年人每年免费提供一次健康体检服务，健康体检是对老年常见疾病“早发现、早诊断、早治疗”的第一步。基本公共卫生服务的老年健康体检服务对老年健康异常状况检出的贡献及老年人获悉情况，相关研究报道较少。本文主要着眼于基本公共卫生服务中老年人健康体检异常检出率进行研究，从需方视角了解国家基本公共卫生服务项目中老年健康体检的效果。目的 了解基本公共卫生服务为65岁以上老年人提供的健康体检服务中异常检出率情况。方法 采用多阶段分层抽样从我国东、中、西部的3省5市20个基层医疗机构中就诊的>=65岁老年人作为调查对象，根据基本公共卫生管理情况，分为一般老年人（不患有高血压或糖尿病）、高血压老年人、糖尿病老年人三类，对所有调查对象进行一对一问卷调查。结果 （1）老年人健康体检异常检出率为67.4%，农村老年人高于城市（70.6%＞64.1%，P＜0.001）；（2）血压异常：老年人体检异常检出率最高的是血压异常，有38.9%的调查对象自报在最近一次的年度体检结果中显示血压异常，农村高于城市（41.2%＞36.6%，P=0.010）；有49.1%的已被诊断为高血压的老年人在年度体检中的血压值异常，36.1%的糖尿病老年人血压值异常，18.3%的一般老年人在最近一次体检中发现了血压值异常。（3）血糖异常：24.8%的调查对象自报最近一次体检中发现了血糖异常；已被诊断为糖尿病的老年人在体检中测量血糖，血糖异常的比例为60.5%，高血压老年人的血糖异常率为9.7%，一般老年人的血糖异常筛查率为8.4%。（4）贫血的总体检出率是2.0%，农村老年人高于城市（2.6%＞1.4%，P=0.021）；脂肪肝的总检出率14.7 %，城市老年人高于农村（17.2%＞12.3%，P＜0.001）。（5）与一般老年人相比，高血糖老年人血压异常检出率是其2.66倍，高血压、高血糖老年人血脂异常检出率分别是其1.64、1.41倍，高血压、高血糖老年人超重肥胖检出率分别是其2.81、2.57倍，高血压、高血糖老年人脂肪肝检出率分别是其2.10、1.52倍，而高血压、高血糖老年人贫血检出率则是一般老年人的0.26、0.50倍；与城市相比，农村老年人的血压异常、血糖异常、贫血分别是其1.29、1.36和1.76倍，而农村老年人的脂肪肝检出率是其0.30倍。结论 健康体检中血压异常检出率较高，高血压、糖尿病老年人自身血压血糖控制有所改善，农村老年人健康防治不如城市。
Background China's national basic public health service provides free health examination services for the older adults aged 65 and above once a year, and health examination is the first step of "early detection, early diagnosis and early treatment" of common diseases in the older adults. The contribution of the older adults health examination service of basic public health services to the detection of health abnormalities in the older adults and the information of the older adults have been reported in less relevant studies. This paper mainly focuses on the abnormal detection rate of health examination of the older adults in basic public health services, and understands the effect of health examination for the older adults in the national basic public health service project from the perspective of the demand side. Objective Understand the abnormal detection rate in the health examination services provided by the basic public health service for the older adults over 65 years of age. Methods Multi-stage stratified sampling was used to take the older adults aged >=65 years old from 20 primary medical institutions in 3 provinces and 5 cities in the eastern, central and western regions of China as the survey subjects, and according to the basic public health management, they were divided into three categories: general older adults (not suffering from hypertension or diabetes), hypertension older adults and diabetic older adults people, and one-to-one questionnaire survey was conducted for all survey subjects. Results (1) The abnormal detection rate of health examination for the older adults was 67.4%, and the rural older adults were higher than those in urban areas (70.6%> 64.1%, P<0.001); (2) Abnormal blood pressure: the highest detection rate of abnormal physical examination in the older adults is abnormal blood pressure, 38.9% of the respondents self-reported abnormal blood pressure in the latest annual physical examination results, which is higher in rural areas than in urban areas (41.2%> 36.6%, P=0.010); 49.1% of the older adults who have been diagnosed with hypertension have abnormal blood pressure values in the annual physical examination, 36.1% of the older adults with diabetes have abnormal blood pressure values, and 18.3% of the general older adults have found abnormal blood pressure values in the latest physical examination. (3) Abnormal blood sugar: 24.8% of the respondents reported that they found abnormal blood glucose in the latest physical examination; The proportion of abnormal blood glucose in the older adults who have been diagnosed with diabetes is 60.5%, the abnormal blood glucose rate of the hypertensive older adults is 9.7%, and the screening rate of abnormal blood glucose in the general older adults is 8.4%. (4) The overall detection rate of anemia was 2.0%, and the older adults in rural areas were higher than those in urban areas (2.6% > 1.4%, P=0.021); The overall detection rate of fatty liver was 14.7%, and the urban older adults were higher than those in rural areas (17.2% > 12.3%, P<0.001). (5) Compared with the general older adults, the detection rate of abnormal blood pressure in the older adults with high blood sugar is 2.66 times, the detection rate of abnormal blood lipids in the older adults with hypertension and hyperglycemia is 1.64 and 1.41 times, the detection rate of overweight and obesity in the older adults with hypertension and hyperglycemia is 2.81 and 2.57 times, the detection rate of fatty liver in the older adults with hypertension and hyperglycemia is 2.10 and 1.52 times, respectively, and the detection rate of anemia in the older adults with hypertension and hyperglycemia is 0.26 and 0.50 times that of the general older adults; Compared with urban areas, the abnormal blood pressure, abnormal blood sugar and anemia of the rural older adults were 1.29, 1.36 and 1.76 times higher, respectively, while the detection rate of fatty liver among the rural older adults was 0.30 times. Conclusion The detection rate of abnormal blood pressure in the health examination is high, the blood pressure and blood sugar control of the older adults with hypertension and diabetes has improved, and the health prevention and treatment of the older adults in rural areas is not as good as that in cities.
李梦宇、廖子锐、刘远立、刘璐、连隽、尤莉莉、昝子晴
预防医学医学研究方法
国家基本公共卫生服务健康体检异常检出老年人
李梦宇,廖子锐,刘远立,刘璐,连隽,尤莉莉,昝子晴.国家基本公共卫生服务老年人健康体检的异常检出率分析[EB/OL].(2022-12-01)[2025-08-02].https://chinaxiv.org/abs/202212.00004.点此复制
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