【作者】 邢海燕；

【导师】 沈毅；

【作者基本信息】 浙江大学 ， 流行病与卫生统计学， 2003， 硕士

【摘要】 目 的目的 近些年来我国社会经济发生了巨大的变化，卫生服务供给，利用和卫生服务需求都发生了显著变化。研究居民卫生服务需求和利用及其影响因素已成为卫生服务研究的重要课题。由于我国对农村计划生育的特殊政策及城市人生育观的改变，从2000年人口发展状况来看，新增人口的90％左右，老龄人口的85％左右将分布在农村，今后农村卫生资源的需求将继续增加。研究我省农村居民的卫生服务状况，对制定医疗卫生规划，加强医疗卫生事业管理有着十分重要的意义。 对应分析是一种描述性的多元统计分析方法，与主成分分析，因子分析，典型相关分析，多维标度法等都是基于奇异值分解，其思想核心是高维空间的向量点向低维空间投影，从而揭示变量间的相关关系及相关程度，具有直观，简单，方便，判别力强，节省运算时间等优点，已被广泛地应用于地质，海洋，气象，医药等各方面的科学研究领域，是一种具有较好前景的统计分析方法。本研究拟采用对应分析方法对农村居民的两周患病治疗方式，两周患病疾病谱，慢性病患病疾病谱与各影响因素之间的关系进行分析。一方面，探讨此方法应用于卫生服务研究的适宜性，另一方面，为卫生部门采取政策，改善医疗保健工作提供参考依据。 资料来源与方法 资料来源于1998年浙江省卫生服务调查家庭健康询问调查。该调查按照四阶段整群随机抽样法从全省抽取12个县7200户住户，其中城市2个，农村10个，本次研究对象为农 浙江大学硕土研究生毕业论文村居民。家庭健康询问调查的内容包括门）调查家庭成员的基本情况；（2）家庭经济，住房情况及环境状况；（）家庭成员享受的医疗保健制度和卫生服务可得性；（4）家庭成员的两周内病伤，半年内慢性病患病及就诊情况等。 因城市地区居民人数较少，列联表中出现较多的0值，不满足对应分析的条件，故本文只分析农村地区居民的卫生服务状况。研究居民两周患病治疗方式与年龄，收入水平，文化程度，疾病严重程度，经常就诊单位，医疗保障形式，离卫生组织距离，去最近卫生组织需要的时间（步行或乘车）等指标之间的关系；居民两周患病疾病谱，慢性病患病疾病谱与年龄，收入水平，文化程度，经常就诊单位，医疗保障形式等指标之间的关系。采用SAS6＊ 对数据进行简单对应分析和多重对应分析。 结 果 两周患病治疗方式与影响因素的关系中，有统计学意义的因素有：年龄，收入水平，疾病严重程度，经常就诊单位，离卫生组织距离和去最近卫生组织所需要的时间。对应分析结果表明大于等于65岁组的老年人，高收入，有严重疾病，经常就诊于门诊部所，医疗点或私人开业，就诊距离在1公里以内，去卫生组织时间在10分钟以内的居民一般选择找医生看病治疗，25－35岁组，疾病不严重或说不好，经常就诊于卫生院，就诊距离3公里以上，去卫生组织时间在30分钟以上的居民一般采取自我医疗，其他的均介于找医生看病和自我医疗之间，通常是两者皆有。 两周患病疾病谱与影响因素的关系中，有统计学意义的因素有：年龄，收入水平，文化程度和医疗保障形式。对应分析结果表明，患循环系统疾病主要为35岁以下，低收入，不识字或识字少，公费劳保的农村居民。患呼吸系统疾病的主要为65岁以上，中等收入，初中以上文化程度，自费的居民。患消化系统疾病的主要为45－65岁，高收入，小学文化程度，自费的居民。患先天异常的主要为45－55岁，低收人，不识字或识字少，公费劳保或自费的居民。患损伤和中毒的主要为45－55岁，中等收入，小学文化程度，合作医疗的居民。患其他疾病的主要为35。55岁，低收人，不识字或识字少或小学文化程度，自费的居民。 慢性病患病疾病谱与影响因素的关系中，有统计学意义的因素有：年龄，收入水平， 2 浙江大学硕士研究生毕业论文文化程度和医疗保障形式。对应分析结果表明，患传染病和寄生虫病的主要为45－55岁，高收入，初中以上文化程度，自费的居民。患循环系统疾病的主要为25－35岁，低收人，不识字或识字少，公费劳保和其它医疗保障形式的居民。患呼吸系统疾病的主要为25岁以下，中等收入，不识字或识字少，合作医疗或自费的居民。患消化系统疾病的主要为45岁以上，高收入，小学以上文化程度，自费的居民。患泌尿生殖系统疾病的主要为55岁以上，中等收入，小学以上文化程度，自费的居民。患先天异常的主要为35－55岁，低收入或中等收入，不识字或识字少的居民。患损伤和中毒的主要为55岁以上，中等收入，小学或初中文化程度，合作医疗的居民。患其它疾病的主要为45岁以上，低收入，不识字或识字少，自费的居民。 结 论 本文利用对应分析对农村居民两周患病治疗方式，两周患病疾病谱和慢性病患病疾病谱与各影响因素之间的关系进行了分析，用对应分析图直观地表更多还原

【Abstract】 ObjectiveWith the rapid growth of economy in recent years, the supply, utilization and requirements of health service in our country have greatly been changed. And it has become a significant study on the requirements, utilization and their affecting factors of health service. Because of the special policy of Birth control in countryside and the changes of the view of Birth of urban resident, 90 percent of increasing population and 85 percent of aged will dwell in countryside based on the status of population development in 2000. The requirements of health resources will increase unceasingly. So the study on the status of health service about country dweller in Zhejiang province is very important to formulate medicine health project and augment health service management.Correspondence analysis is a descriptive multiple statistical analysis method, based on singular value decomposition principal which is similar to principal component analysis, factor analysis, canonical correlation analysis and multidimensional scaling. The core is that the vector point in high dimension space project to low dimension space, thus it can reveal the correlation relationship and degree between variables. It possesses many virtues such as directness,simpleness, convenience, accurate judgement and decreasing calculating time. So it has been applied extensively in geology, ocean, meteorology, medicine and etc. Our objective is to analyze the relationship between treatment fashion within 2 weeks, disease pattern within 2 weeks, disease pattern of chronic disease and their affecting factors, further to find out whether the correspondence analysis is suitable to health service study and to provide reference criteria for ministry of health to enact policy and ameliorate medical care.Materials and methodsThe data in this study came from the family health survey of Zhejiang Province in 1998. 7200 families from 12 counties (2 town, 10 countryside) were selected by four-stage cluster sampling. The content of the survey was composed of (1) general characteristics of family members; (2) economic and housing conditions and surroundings of the family; (3) health insurance situation and acquirement of health service of family members; (4) circumstance of family members about whether they had illness within 2 weeks and chronic disease within recent six months and whether they went to see doctors.There were few people in urban region in this survey and more 0 values in contingency table, which didn’t coincide with the condition of correspondence analysis, so we only analyzed health service status in rural region. Study on the relationship between treatment fashion within 2 weeks and affecting factors such as age, income, education, serious degree of disease, medical facility, health insurance pattern, distance from the family to the health constitution, time spent of walking or riding to health constitution; the relationship between disease pattern within 2 weeks, disease pattern of chronic disease and their affecting factors such as age, income, education, medical facility health insurance pattern. Statistical analysis was performed by simple correspondence analysis and multi-correspondence analysis, using SAS6.12.ResultsThere were significant differences in the relationship between treatment fashion within 2 weeks and affecting factors including age, income, serious degree of disease, medical facility, distance from family to health constitution, time spent of walking or riding to health constitution. The results by correspondence analysis showed that they generally chose to see doctor, who were with age ≥65, high income, serious disease, usually seeing doctor in ambulant clinic or medicine point or private clinic, with distance ≤1km (kilometer), with time≤10 m (minut); People choosing self-medicine usually were with age ≥25 and age <35, minimal or unknown disease, usually seeing doctor in public health center, with distance≥3km, with time ≥30 m; Others chose seeing doctor or self-medicine, usually they chose both.更多还原