近日，我院姚强副教授及其合作者在卫生管理国际权威期刊《BMJ Global Health》发表题为“Decomposing Income-Related Inequality in Health-Related Quality of Life in Mainland China: A National Cross-Sectional Study”的原创性研究成果。
文章简介：健康与公平是卫生系统的重要目标，了解居民的健康公平性对于卫生的评价及政策制定具有重要意义。本研究通过全国性的中国居民心理与行为调查研究(Psychology and Behavior Investigation of Chinese Residents, PBICR)，利用集中指数及其分解方法和EQ-5D-5L量表，分析了我国居民健康相关生命质量的不平等水平及其影响因素，结果显示，我国健康不平等水平总体较低但是仍然存在亲富性不平等，健康素养、慢性病患病以及经济收入水平是导致健康不平等在主要因素，农村和西部地区健康不平等水平相对较高。因此，降低居民健康素养、慢性病及其经济收入不平等情况，尤其是农村和西部不发达地区，对于提高卫生系统的公平性具有重要意义。
Abstract：Introduction Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China.
Methods Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method.
Results The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (−3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (−5.24%) was the top negative contributor, followed by commercial (−1.43%) and basic medical insurance (−0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134).
Conclusion Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.
论文链接地址：https://gh.bmj.com/content/8/11/e013350.full。
作者简介：姚强，武汉大学welcome网站注册入口副教授，公共事业管理系副主任，武汉大学健康治理研究中心副主任，武汉大学社会保障研究中心、国家医疗保障研究院华科基地研究员，澳大利亚La Trobe大学访问学者，《中国医院管理》杂志青年编委。目前，在Bulletin of the World Health Organization, BMJ Global Health, Journal of Global Health, International Journal for Equity in Health, Health and Quality of Life Outcomes, Health Research Policy and Systems, 人口与发展，统计与信息论坛，中国卫生政策研究等国内外杂志发表学术论文100余篇，中国社会科学出版社出版个人学术专著1部，参编《医疗保障学》《卫生信息资源规划与管理》《文献综述与开题报告》《医院管理与卫生政策研究方法》等国家、省部级规划教材4部。主持国家级、省部级和学校各类项目共20余项。主要研究领域为卫生服务、健康保障、健康公平等。
