Introduction
Materials and methods
Data sources
Evaluation model
Variable category | First-level indicators | Secondary indicators | Meaning | Assigned value |
---|---|---|---|---|
Functional independent variables | Health status (Y1) | Behavioral capacity (x 1) | Level of behavioral ability such as autonomous walking and recognizing orientation | 0-2a |
Self-care (x 2) | Level of self-care ability such as washing, dressing, and using the toilet | 0–2 | ||
Daily activities (x 3) | Level of ability to perform daily activities such as work, reading, or household chores | 0–2 | ||
Physical pain (x 4) | The extent to feel pain or discomfort | 0–2 | ||
Anxiety or depression (x 5) | The severity of conditions such as anxiety or depression | 0–2 | ||
Health literacy and behavior (Y2) | Communication (x 6) | Ease of communication with providers when accessing health or preventive care services | 0-4b | |
Health information (x 7) | The extent to actively read information about health or wellness | 0–4 | ||
Information utilization (x 8) | The extent to which change one's own lifestyle as directed by health or wellness information | 0–4 | ||
Smokingc (x 9) | Whether to smoking (smoking refers to those who have smoked continuously or accumulatively for 6 months or more) | 0–2 | ||
Drinkingc (x 10) | Whether to drink alcohol (drinking refers to drinking at least once a week for six months or more) | 0–2 | ||
Physical exercise (x 11) | Average weekly physical activity in the past 30 days | 0-7d | ||
Preventive care services utilization (Y3) | Health checkup (x 12) | Whether to have participated in regular health examinations (non-entry physical examinations, non-disease-related examinations) | 0-1e | |
Family doctor (x 13) | Whether there is a contract with a family doctor | 0–1 | ||
Health publicity (x 14) | Have you received health publicity/guidance provided by primary medical institutions, et al.? (Excluding disease follow-up and follow-up) | 0–1 | ||
Outcome variable | Health promotion service demands (Y4) | Health guidance (x 15) | The degree of demand for the method and intensity of fitness and health care provided guide by community/village clinics, et al | 0–4 |
Health education (x 16) | The degree of need for information such as health care knowledge and healthy life guidance provided by the Internet and other channels | 0–4 | ||
Health care (x 17) | The degree of need for regular medical check-ups and home care services | 0–4 |
Structural Equation Model (SEM)
Weighted TOPSIS method
Rank Sum Ratio method and T Theil index
Statistical analysis
Results
Basic information
Index | Older adults (people (%)) | Scorea\(\left(\overline{x}\pm s\right)\) | t/F | P |
---|---|---|---|---|
Age (years) | ||||
65 ≤ Age < 70 | 703 (45.59) | 42.43 ± 1.55 | 2.891 | 0.021 |
70 ≤ Age < 75 | 433 (28.08) | 42.67 ± 1.45 | ||
75 ≤ Age < 80 | 206 (13.36) | 42.67 ± 1.45 | ||
80 ≤ Age < 85 | 147 (9.53) | 42.62 ± 1.51 | ||
Age > = 85 | 53 (3.44) | 42.91 ± 1.39 | ||
Sex | ||||
Male | 764 (49.55) | 42.32 ± 1.49 | -6.332 | < 0.001 |
Female | 778 (50.45) | 42.80 ± 1.49 | ||
Residence | ||||
Rural | 863 (55.97) | 41.79 ± 1.27 | -27.924 | < 0.001 |
Urban | 679 (44.03) | 43.55 ± 1.17 | ||
Education level | ||||
Illiteracy | 360 (23.35) | 41.98 ± 1.38 | 73.678 | < 0.001 |
Primary school | 600 (38.91) | 42.22 ± 1.42 | ||
Junior high school | 305 (19.78) | 42.98 ± 1.37 | ||
High school/Technical school | 157 (10.18) | 43.50 ± 1.44 | ||
College degree and above | 120 (7.78) | 43.79 ± 1.12 | ||
Pre-retirement occupationb | ||||
Government staffs | 349 (22.63) | 43.52 ± 1.30 | 295.453 | < 0.001 |
Industry and service workers | 280 (18.16) | 43.52 ± 1.14 | ||
Agricultural sector or others | 913 (59.21) | 41.91 ± 1.31 | ||
Marital status | ||||
Unmarried | 25 (1.62) | 42.25 ± 1.62 | 1.563 | 0.210 |
Married | 1155 (74.90) | 42.60 ± 1.50 | ||
Divorced, widowed and others | 362 (23.48) | 42.47 ± 1.51 | ||
Medical insurancec | ||||
Basic Medical Insurance for Urban Employeesd | 512 (33.20) | 43.57 ± 1.19 | 223.095 | < 0.001 |
Basic Medical Insurance for Residentse | 996 (64.59) | 42.05 ± 1.39 | ||
Others | 34 (2.21) | 42.53 ± 1.43 |
Current state and influencing factors of DOAHPS
The current state of DOAHPS
Indicators | Weight coefficient | Sequence | Scorea\(\left(\overline{x}\pm s\right)\) | Sequence |
---|---|---|---|---|
Health status | 0.2800 | - | ||
Behavioral capacityb | 0.0558 | 11 | 53.04 ± 16.93 | 2 |
Self-care | 0.0541 | 12 | 48.23 ± 14.53 | 4 |
Daily activities | 0.0563 | 10 | 53.79 ± 15.40 | 1 |
Physical pain | 0.0604 | 9 | 43.85 ± 14.61 | 5 |
Anxiety or depression | 0.0534 | 13 | 39.34 ± 12.68 | 8 |
Health literacy and behavior | 0.3879 | - | ||
Communicationc | 0.0412 | 14 | 48.42 ± 14.36 | 3 |
Health information | 0.0681 | 6 | 37.83 ± 21.17 | 9 |
Information utilizationd | 0.0651 | 8 | 34.12 ± 17.96 | 12 |
Smoking | 0.0687 | 5 | 41.81 ± 21.11 | 7 |
Drinking | 0.0674 | 7 | 43.42 ± 21.35 | 6 |
Physical exercise | 0.0774 | 4 | 37.70 ± 35.14 | 10 |
Preventive care service utilization | 0.3321 | - | ||
Health checkupe | 0.0905 | 3 | 34.56 ± 18.16 | 11 |
Family doctor | 0.1245 | 1 | 20.67 ± 19.86 | 13 |
Health publicityf | 0.1171 | 2 | 27.98 ± 23.92 | 14 |
The influencing factors of DOAHPS
Variables | Assignment |
---|---|
DOAHPSa | < 43 points = 0, ≥ 43 points = 1 |
Age | 65 ≤ Age < 70 = 1, 70 ≤ Age < 75 = 2, 75 ≤ Age < 80 = 3, 80 ≤ Age < 85 = 4, Age > = 85 = 5 |
Sex | Male = 0, Female = 1 |
Residence | Rural = 0, Urban = 1 |
Education level | Illiteracy = 1, Primary school = 2, Junior high school = 3, High School/Technical School = 4, College degree and above = 5 |
Pre-retirement occupation | Government staffs = 1, Industry and service workers = 2, Agricultural sector or others = 3 |
Medical insurance | Basic Medical Insurance for Urban Employees = 1, Basic Medical Insurance for Residents = 2, Others = 3 |
Indicators | β | SEa | Walsb | P | OR (95%CI) |
---|---|---|---|---|---|
Sex | 0.767 | 0.142 | 29.122 | < 0.001 | 2.154 (1.630 ~ 2.846) |
Age (Age > = 85) | - | - | 8.529 | 0.074 | - |
65 ≤ Age < 70 | 0.349 | 0.352 | 0.984 | 0.321 | 1.418 (0.711 ~ 2.826) |
70 ≤ Age < 75 | 0.298 | 0.357 | 0.696 | 0.404 | 1.347 (0.669 ~ 2.715) |
75 ≤ Age < 80 | 0.085 | 0.378 | 0.051 | 0.822 | 1.089 (0.519 ~ 2.284) |
80 ≤ Age < 85 | -0.289 | 0.385 | 0.564 | 0.453 | 0.749 (0.352 ~ 1.593) |
Residence | 1.862 | 0.212 | 77.001 | < 0.001 | 6.437 (4.247 ~ 9.757) |
Education level (College degree and above) | - | - | 15.077 | 0.005 | - |
Illiteracy | -1.197 | 0.334 | 12.854 | < 0.001 | 0.302 (0.157 ~ 0.581) |
Primary school | -0.924 | 0.310 | 8.898 | 0.003 | 0.397 (0.216 ~ 0.728) |
Junior high school | -0.572 | 0.305 | 3.517 | 0.061 | 0.565 (0.311 ~ 1.026) |
High school/Technical school | -0.624 | 0.311 | 4.011 | 0.045 | 0.536 (0.291 ~ 0.987) |
Pre-retirement occupation (Agricultural sector or others) | - | - | 15.115 | 0.001 | - |
Government staffs | 0.535 | 0.248 | 4.650 | 0.031 | 1.707 (1.050 ~ 2.775) |
Industry and service workers | 0.885 | 0.228 | 15.091 | < 0.001 | 2.422 (1.550 ~ 3.786) |
Medical insurance (Others) | - | - | 2.708 | 0.258 | - |
Basic Medical Insurance for Urban Employeesc | 0.543 | 0.445 | 1.493 | 0.222 | 1.722 (0.720 ~ 4.118) |
Basic Medical Insurance for Residentsd | 0.262 | 0.448 | 0.342 | 0.559 | 1.300 (0.540 ~ 3.130) |
Constant | -4.360 | 0.706 | 38.096 | < 0.001 | 0.013 |
Equity level of allocation of DOAHPS among older adults with different characteristics and its influencing factors
The equity level of allocation of DOAHPS
Indicators | Grade (People(%)) | χ2 | P | ||||
---|---|---|---|---|---|---|---|
Very poor | Poor | General | High | Very high | |||
Sex | |||||||
Male | 26 (3.40) | 255 (33.38) | 393 (51.44) | 87 (11.39) | 3 (0.39) | 38.991 | < 0.001 |
Female | 9 (1.16) | 186 (23.91) | 425 (54.63) | 151 (19.41) | 7 (0.90) | ||
Residence | |||||||
Rural | 31 (3.59) | 395 (45.77) | 389 (45.08) | 43 (4.98) | 5 (0.58) | 379.501 | < 0.001 |
Urban | 4 (0.59) | 46 (6.77) | 429 (63.18) | 195 (28.72) | 5 (0.74) | ||
Education level | |||||||
Illiteracy | 12 (3.33) | 153 (42.50) | 171 (47.50) | 24 (6.67) | 0 (0.00) | 323.431c | < 0.001 |
Primary school | 18 (3.30) | 211 (35.17) | 309 (51.50) | 61 (10.17) | 1 (0.17) | ||
Junior high school | 2 (0.66) | 63 (20.66) | 177 (58.03) | 58 (19.02) | 5 (1.64) | ||
High school/Technical school | 2 (1.27) | 7 (4.46) | 98 (62.42) | 49 (31.21) | 1 (0.64) | ||
College degree and above | 1 (0.83) | 7 (5.83) | 63 (52.50) | 46 (38.33) | 3 (2.50) | ||
Pre-retirement occupationb | |||||||
Government staffs | 2 (0.57) | 29 (8.31) | 207 (59.31) | 107 (30.66) | 4 (1.15) | 244.906 | < 0.001 |
Industry and service workers | 2 (0.71) | 23 (8.21) | 171 (61.07) | 81 (28.93) | 3 (1.07) | ||
Agricultural sector or others | 31 (3.40) | 389 (42.61) | 440 (48.19) | 50 (5.48) | 3 (0.33) | ||
Total | 35 (2.27) | 441 (28.60) | 818 (53.05) | 238 (15.43) | 10 (0.65) | - | - |
Influencing factors of DOAHPS’ equity level
Indicators | T Theil index (contribution rate) | Total (10–4) | Sex (10–4) | Residence (10–4) | ||
---|---|---|---|---|---|---|
Male | Female | Rural | Urban | |||
Education level | T Total Theil Index | 2.7433 | 2.6842 | 2.6647 | 1.9806 | 1.6462 |
T Theil index within group (%) | 2.3096 (84.19) | 2.0909 (77.90) | 2.2029 (82.67) | 1.9229 (97.08) | 1.6255 (98.74) | |
T Theil index between groups (%) | 0.4336 (15.81) | 0.5933 (22.10) | 0.4618 (17.33) | 0.0577 (2.92) | 0.0207 (1.26) | |
Pre-retirement occupationb | T Total Theil Index | 2.7433 | 2.6842 | 2.6647 | 1.9806 | 1.6462 |
T Theil index within group (%) | 1.9930 (72.66) | 1.8327 (68.28) | 1.9967 (74.93) | 1.9304 (97.46) | 1.6255 (98.74) | |
T Theil index between groups (%) | 0.7499 (27.34) | 0.8514 (31.72) | 0.6680 (25.07) | 0.0502 (2.54) | 0.0207 (1.26) |