中国流动人口自评健康状况影响因素及公平性

doi:10.19723/j.issn.1671-167X.2024.02.004

摘要/Abstract

摘要：

目的: 了解中国流动人口健康状况及其空间分布和影响因素，评价健康公平性。方法: 使用2017年国家流动人口动态监测数据，采用二分类Logistic回归分析流动人口健康状况影响因素，采用集中指数法分析流动人口健康公平性，采用空间自相关法分析健康状况和健康公平性的空间聚集。结果: 中国流动人口不健康率为2.71%。年龄和性别对自评健康有显著影响，即随着年龄的增长，流动人口的自评健康逐渐变差，同时女性更容易认为自己不健康。公平性分析显示流动人口的集中指数为0.021 7，城市户籍流动人口为0.021 6，农村户籍流动人口为0.021 9，表明流动人口健康状况公平性偏向高收入阶层，农村户籍流动人口健康不公平程度大于城市户籍流动人口。自评健康全局Moran’ s i=0.211，不健康率全局Moran’ s i=0.291，表明自评健康有空间聚集趋势。流动人口两周患病率公平性Moran’ s i=0.136, 显示出空间聚集特征，且以北部和东南沿海地区为主。结论: 总体上中国流动人口健康状况较好，健康影响因素包括性别、年龄，健康不公平的集中趋势体现在东南沿海和北部地区，具有倾贫性特征。

关键词: 流动人口, 健康公平, 影响因素, 空间差异

Abstract:

Objective: To understand the health status, influencing factors and spatial distribution of the Chinese floating population and to evaluate the health equity of the floating population. Methods: All the data were collected from the 2017 Migrant Population Dynamic Monitoring Survey in China, binary Logistic regression was used to analyze the factors that might affect the health of the floating population, and the concentration index method was used to evaluate the health equity of the floating population. Spatial autocorrelation analyses the spatial aggregation of health status and health equity. Results: The unhealthy rate of the floating population in China was 2.71%. Age and gender show a statistically significant impact on self-rated health; that is, as age increases, the self-rated health of the migrant population gradually deteriorates, and women are more likely to think that they are unhealthy. Fairness analysis shows that the concentration index of the floating population is 0.021 7, the urban household registration floating population is 0.021 6, and the rural household registration floating population is 0.021 9. It is shown that the fairness of the health status of the floating population is biased towards the high-income class, and the rural household registration floating population' s health unfairness is greater than that of the urban household registration migration population. Moreover, Moran' s i=0.211 for self-rated health and Moran' s i=0.291 for the unhealthy rate indicate that self-rated health has a spatial aggregation trend. Moran' s i=0.136 showed the characteristics of spatial clustering, and the two-week prevalence fairness of the floating population was mainly in the northern and southeastern coastal areas. Conclusion: In general, the health status of the floating population in China is relatively good. The main influencing factors of health included gender and age. The central tendency of health inequity is reflected in the southeast coastal and northern regions, which are characterized by poverty. Attention to spatial aggregation is not only helpful to analyze the reasons of floating population, but also to study the health differences between different regions and health-related factors, to improve the overall health level of the whole population.

Key words: Floating population, Health equity, Influencing factors, Spatial differences

中图分类号:

R195

刘笑晗,杨帆,王昕迪,黄宁,程陶朱,郭静. 中国流动人口自评健康状况影响因素及公平性[J]. 北京大学学报（医学版）, 2024, 56(2): 223-229.

Xiaohan LIU,Fan YANG,Xindi WANG,Ning HUANG,Taozhu CHENG,Jing GUO. Related factors and equity of health status among floating population in China based on geographic information system analysis[J]. Journal of Peking University (Health Sciences), 2024, 56(2): 223-229.

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Variables	Definition	Frequency	Percentage
Self-rated health	Health=0	165 263	97.29
	Unhealth=1	4 602	2.71
Gender	Female=0	82 066	48.31
	Male=1	87 799	51.69
Residence	Rural=1	132 555	78.04
	Non-rural=0	37 310	21.96
Education	Primary school and below=1	28 965	17.05
	Middle school=2	74 173	43.67
	High school=3	37 187	21.89
	University and above =4	29 540	17.39
Marriage status	Else(single/divorce et al)=0	31 882	18.77
	Married=1	137 983	81.23
Health insurance status	Yes=1	155 996	93.50
	No=0	10 848	6.50
Range of population flow	Trans-provincial flow=1	83 700	49.27
	Inter-city mobility=2	55 993	32.96
	Inter-county mobility=3	30 172	17.76
Reasons of population flow	For work=1	142 016	83.61
	For family=2	14 674	8.64
	For retirement=3	13 175	7.76
Ill within two weeks	Yes=1	158 873	93.53
	No=0	10 992	6.47
Location	Northeast=1	12 997	7.65
	West=2	58 916	34.68
	Middle=3	28 988	17.07
	East=4	68 964	40.60

Variables	OR	95%CI
Gender(ref：Female)	0.829^*	0.704-0.977
Age	1.074^#	1.065-1.082
Residence(ref：Non-rural)	1.001	0.776-1.290
Education(ref：Primary school and below)
Middle school	0.514^#	0.426-0.620
High school	0.324^#	0.245-0.429
University and above	0.202^#	0.119-0.343
Marriage status[ref：Else(single/divorce et al)]	1.055	0.812-1.372
Health insurance status(ref：No)	0.994	0.675-1.464
Range of population flow(ref：Trans- provincial flow)
Inter-city mobility	0.819^☆	0.676-0.993
Inter-county mobility	1.213^☆	1.010-1.456
Flow duration	1.010^*	1.001-1.020
Reasons of population flow(ref：For work)
For family	1.248	0.856-1.818
For retirement	1.681^☆	1.048-2.696
Income	0.838^#	0.809-0.869
Location(ref：Northeast)
West	1.028	0.848-1.246
Middle	0.755^☆	0.604-0.943
East	0.499^#	0.399-0.623

Household group	Urban		Rural		Total
Household group	N	Self-rated unhealthy, n(%)	N	Self-rated unhealthy, n(%)	N	Self-rated unhealthy, n(%)
Low-income	4 214	121 (2.87)	24 430	915 (3.75)	28 644	1 036 (3.62)
Low to middle income	6 381	60 (0.94)	27 532	249 (0.90)	33 913	409 (1.21)
Middle-income	5 775	49 (0.85)	21 603	197 (0.91)	27 378	246 (0.90)
Middle to high income	4 923	30 (0.61)	16 685	128 (0.77)	21 608	158 (0.73)
High-income	8 381	27 (0.32)	19 482	116 (0.60)	27 863	143 (0.51)
P/CI SE	< 0.001/0.014		< 0.001/0.033		< 0.001/0.013

Variables	β	SE	t	P
Constant	-0.202	0.719	-0.280	0.783
Age	0.003	0.009	0.380	0.709
Gender (ref：Female)	0.950	0.619	1.535	0.146
Residence (ref：Non-rural)	-0.263	0.097	-2.715	0.016
Marriage status [ref：Else (single/divorce et al)]	0.661	0.251	2.631	0.019
Health insurance status (ref：No)	-0.312	0.412	-0.757	0.461
Reasons of population flow (ref：For work)
For family	-0.298	0.347	-0.859	0.404
For retirement	0.269	0.468	0.576	0.573
Education (ref：Primary school and below)
Middle school	-0.353	0.315	-1.121	0.280
High school	0.449	0.345	1.302	0.213
University and above	-0.197	0.277	-0.710	0.489
Range of population flow (ref：Trans-provincial flow)
Inter-city mobility	-0.309	0.090	-3.453	0.004
Inter-county mobility	0.006	0.071	0.087	0.931
Flow duration	-0.032	0.012	-2.724	0.016
Income	< 0.001	< 0.001	-1.213	0.244