目的:分析河南省老年人患慢性病与社会参与能力的相关性.方法:于2019年采用多阶段分层整群抽样法抽取河南省18个市的60岁及以上老年人进行现场访谈式问卷调查.使用一般资料调查表收集老年人患慢性病情况,通过《老年人能力评估标准:MZ/T 039-2013》对其社会参与能力进行评估.采用二分类Logistic回归模型分析患慢性病对老年人社会参与能力的影响.结果:河南省老年人的社会参与能力受损检出率为20.18％(1123/5565).患有慢性病的老年人社会参与能力受损检出率28.24％(844/2989),高于未患慢性病者[10.83％(279/2576)].Logistic回归分析显示老年人高血压、糖尿病、冠心病、慢性阻塞性肺疾病(慢阻肺)、其他慢性病、高血压+冠心病、高血压+糖尿病、冠心病+糖尿病、高血压+慢阻肺及高血压+冠心病+糖尿病与社会参与能力受损有关联;与未患慢性病的老年人相比,患1种或多种慢性病组合共病会增加社会参与能力受损的危险性.结论:河南省老年人患慢性病与社会参与能力受损相关,患慢性病以及多种慢性病情况会增加老年人社会参与能力受损的风险.

Objective To understand the status of chronic diseases and mental state of the elderly in Henan Province, analyze their correlation, and provide reference for the prevention and management of chronic diseases and the regulation of mental state of the elderly. Methods The elderly aged 60 and above were selected in 18 cities of Henan Province by multi-stage stratified cluster sampling method, and conducted on-site interview questionnaire survey. SPSS24.0 software was used for descriptive analysis, correlation analysis and regression analysis. Results The detection rate of impaired mental status of the elderly was 34.05%. The detection rate of impaired mental status of the elderly with chronic disease was 41.04%, which was higher than that of the elderly without chronic disease（25.92%）. Binary logistic regression analysis showed that suffering hypertension, diabetes, coronary heart disease, malignant tumor, stroke, other chronic diseases, hypertension + stroke, diabetes + chronic obstructive pulmonary disease and the number of chronic diseases were associated with impaired mental state. Compared with the elderly without chronic diseases, comorbidity of one or more chronic diseases increases the risk of impaired mental status. Conclusion Chronic diseases are associated with the impaired mental state in the elderly. Chronic diseases and multiple chronic diseases will increase the risk of impaired mental state in the elderly. It is necessary to implement health management and prevention on chronic diseases in the elderly.

目的:探讨河南省老年人自我医疗状况及影响因素.方法:采用多阶段整群随机抽样抽取7597名河南省60岁及以上老年人为研究对象,对"两周内是否因为不舒服用药或采取自我医疗措施"进行家庭健康调查,基于传统安德森卫生服务行为模型进行Logistic回归分析.结果:7957人中,有自我医疗行为2606人(32.75％);日常居住地为农村(OR=0.518,95％CI:0.454～0.592)、城乡居民医保(OR=0.514,95％CI:0.443～0.597)的老年人选择自我医疗的倾向性较低;年龄在70～79岁(OR=1.168,95％CI:1.032～1.322)、女性(OR=1.173,95％CI:1.046～1.315)、近1 a没有接受健康体检(OR=1.144,95％CI:1.019～1.284)、从家到最近医疗机构的时间在11～30 min(OR=1.215,95％CI:1.023～1.444)和>30 min(OR=2.237,95％CI:1.094～4.577)、患1种慢性病(OR=10.370,95％CI:8.877～12.115)和患≥2种慢性病(OR=28.167,95％CI:23.673～33.514)的老年人更倾向进行自我医疗.结论:年龄、性别、日常居住地、近1a健康体检情况以及就医便利程度、医保类型、慢性病种数是影响河南省老年人自我医疗行为的主要因素.

Background Disability influences physical and mental health of older people, and causes a heavy burden on family and society. The increasing prevalence of empty-nested phenomenon has aroused wide concern for empty and non-empty nesters. Objective To investigate the prevalence and associated factors of comprehensive disability in empty and non-empty nesters in Henan, providing a scientific basis for the prevention and control of disability among these people. Methods By use of multistage stratified sampling, 5 570 older people aged ≥60 years were selected from Henan's 18 provincial cities from January to September 2019 for a questionnaire survey. The comprehensive ability of them was assessed by using the Ability Assessment for Older Adults Scale developed by the Ministry of Civil Affairs of the People's Republic of China. Binary Logistic stepwise regression analysis was used to identify the factors associated with comprehensive disability. Results The participants included 3 731 empty nesters and 1 839 non-empty nesters. The prevalence of intact comprehensive ability, and comprehensive disability in empty nesters was 51.97% (1 939/3 731) , and 48.03% 〔1 792 (1 417 mild, 217 moderate, and 104 severe) /3 731〕, respectively. The prevalence of intact comprehensive ability, and comprehensive disability in non-empty nesters was 44.64% (821/1 839) , and 55.36% 〔1 018 (820 mild, 123 moderate, and 75 severe) /1 839〕, respectively. Empty nesters had lower prevalence of comprehensive disability than did non-empty nesters (χ2=26.448, P<0.001) . Empty and non-empty nesters had significant differences in sex ratio, age distribution, marital status, education level, monthly income, financial support from children, prevalence of disability and accidents (P<0.05) . Stepwise binary Logistic regression analysis showed that age, prevalence of disability and accidents as well as number of chronic diseases were associated with comprehensive disability prevalence in both empty and non-empty nesters, and the specific corresponding data with values of OR and 95%CI were as follows: age 〔70-79 years, OR=1.590, 95%CI (1.373, 1.842) ; ≥80 years, OR=2.429, 95%CI (1.934, 3.050) 〕, disability 〔OR=3.803, 95%CI (2.924, 4.947) 〕, accidents 〔OR=2.747, 95%CI (2.101, 3.591) 〕, and number of chronic diseases 〔4-7, OR=6.549, 95%CI (3.736, 11.482) 〕were associated with comprehensive disability prevalence in empty nesters (P<0.05) . Age〔70-79 years, OR=1.357, 95%CI (1.084, 1.699) ; ≥80 years, OR=3.784, 95%CI (2.820, 5.076) 〕, disability〔OR=3.523, 95%CI (2.413, 5.145) 〕, accidents〔OR=2.789, 95%CI (1.962, 3.965) 〕 and number of chronic diseases 〔4-7, OR=2.997, 95%CI (1.460, 6.151) 〕 were associated with comprehensive disability prevalence in non-empty nesters (P<0.05) . In addition, comprehensive disability prevalence in empty nesters was also affected by education level 〔primary school: OR=0.748, 95%CI (0.629, 0.890) ; middle school: OR=0.776, 95%CI (0.634, 0.949) 〕, and financial support from children〔OR=1.318, 95%CI (1.146, 1.516) 〕 (P<0.05) . And comprehensive disability prevalence in non-empty nesters was also influenced by marital status 〔unmarried/divorced/widowed: OR=1.291, 95%CI (1.047, 1.592) 〕 and monthly income 〔1 001-2 000 yuan: OR=0.574, 95%CI (0.443, 0.743) 〕 (P<0.05) . Conclusion The associated factors of comprehensive disability prevalence for Henan's empty and non-empty nesters were not completely the same. Age, prevalence of disability, and accidents as well as number of chronic diseases were associated with comprehensive disability in both of them. Other associated factors of comprehensive disability were education level and financial support from children for empty nesters, and were marital status and monthly income for non-empty-nesters. So targeted interventions delivered to these two groups should be different.

目的:探究河南省中老年人两周内基层首诊医疗机构选择情况及影响因素,为优化基层首诊就医选择提供建议.方法:采用多阶段分层整群随机抽样法,抽取河南省9个省辖市≥45岁的中老年人进行问卷调查.运用SPSS24.0进行描述分析、单因素分析以及二分类logistic回归分析,探究中老年人在两周病伤内首诊医疗机构选择及影响因素分析.结果:77.47％的中老年人选择到基层医疗机构首诊.回归分析结果表明,城镇职工基本医保、是否有健康档案、焦虑或抑郁、自评健康、是否饮酒、是否有其他慢性病是影响中老年人在两周病伤内选择基层首诊的因素.结论:基层医疗机构应充分发挥医疗保险的优势,完善健康档案,关注中老年人群的身心健康,采取针对性措施提升慢性病诊疗水平,加强健康管理宣教,加大分级诊疗宣传力度,合理引导中老年人选择基层医疗机构就诊.