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Article(id=1240972419620458649, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310179, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1697212800000, receivedDateStr=2023-10-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800480989, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800480989, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800480989, creator=13701087609, updateTime=1773800480989, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1630, endPage=1636, ext={EN=ArticleExt(id=1240972419914059932, articleId=1240972419620458649, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The effect of the establishment of health records on the utilization of health management services for patients with chronic diseases in young and middle-aged floating population: a case study of hypertension and type 2 diabetes mellitus, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the effect of establishing health records on the acceptance of health management services in young and middle-aged floating population with hypertension and type 2 diabetes, and to provide references for improving the utilization rate of health management services and realizing the equalization of basic public health services.

Methods

Based on the population characteristics, family characteristics, health and public service characteristics of 6 391 young and middle-aged patients with chronic diseases aged 30 to 59 years old in 2017, Probit model and tendency score matching method were used to analyze the effect of health files on the acceptance of health management services in young and middle-aged floating population with hypertension and type 2 diabetes.

Results

The results of Probit model showed that the coefficients of establishing health records for hypertension patients, type 2 diabetes patients, and patients with both diseases were 0.940, 0.905, and 1.333, respectively, and they were all significant at 1% level, indicating that the establishment of health records had a positive effect on the health management services of young and middle-aged floating population with chronic diseases. After correcting the endogenous problems of the model, the result remained robust. Heterogeneity analysis found that there were differences in age, self-rated health, and health education in the establishment of health records.

Conclusion

The establishment of health records has a positive impact on the acceptance of health management services for patients with chronic diseases in young and middle-aged floating population. In the future, we should pay attention to the basic public health service needs of patients with hypertension and type 2 diabetes in young and middle-aged floating population, carry out health education and publicity work for patients with different characteristics, and improve the awareness and utilization rate of basic public health services.

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目的

了解中青年流动人口高血压和2型糖尿病患者建立健康档案对其接受健康管理服务的影响，为提高健康管理服务利用率，实现基本公共卫生服务均等化提供参考。

方法

基于2017年全国流动人口卫生计生动态监测数据中6 391名30～59岁中青年慢性病患者人口特征、家庭特征、健康与公共服务特征资料，运用Probit模型及倾向得分匹配法分析健康档案对中青年流动人口高血压及2型糖尿病患者接受健康管理服务的影响。

结果

Probit模型结果显示，高血压患者、2型糖尿病患者及两病共患者建立健康档案的系数分别为0.940、0.905、1.333，且均在1%水平上显著，即建立健康档案对中青年流动人口慢性病患者接受健康管理服务有正向作用。纠正模型内生性问题后，这一结果仍然稳健。异质性分析发现建立健康档案对接受健康管理服务存在年龄、自评健康及健康教育差异。

结论

建立健康档案对中青年流动人口慢性病患者接受健康管理服务有正向影响。今后应关注中青年流动人口高血压和2型糖尿病患者的基本公共卫生服务需求，针对不同特征的患者开展健康教育宣传工作，提高基本公共卫生服务知晓率与使用率。

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梁立波，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=BXj00wbjnFQ0ipvcaiin8w==, magXml=5iuIJndOdEgeoIO8c95cVA==, pdfUrl=null, pdf=vQN0yF75ao7a75M+QVqqvA==, pdfFileSize=1106633, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=BQRNXKzFS31cxKbU1DnPzQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=BaRAYCJgrLIpE7y/iiB5gg==, mapNumber=null, authorCompany=null, fund=null, authors=

王楠（1999—），女，硕士研究生，研究方向：人群健康研究工作

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王楠（1999—），女，硕士研究生，研究方向：人群健康研究工作

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王楠（1999—），女，硕士研究生，研究方向：人群健康研究工作

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Comparison of the clinical characteristics of young and elderly patients with hypertension[J]. Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine: Electronic, 2020, 8(2): 69, 71., articleTitle=Comparison of the clinical characteristics of young and elderly patients with hypertension, refAbstract=null), Reference(id=1240986277777043486, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, doi=null, pmid=null, pmcid=null, year=2023, volume=37, issue=3, pageStart=85, pageEnd=89, url=null, language=null, rfNumber=[17], rfOrder=31, authorNames=王婉晨, 尹文强, journalName=卫生软科学, refType=null, unstructuredReference=王婉晨， 尹文强.中国青年流动人口健康档案建立现状及影响因素分析[J].卫生软科学，2023，37（3）：85-89., articleTitle=中国青年流动人口健康档案建立现状及影响因素分析, refAbstract=null), Reference(id=1240986277936427041, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, doi=null, pmid=null, pmcid=null, year=2023, volume=37, issue=3, pageStart=85, pageEnd=89, url=null, language=null, rfNumber=[17], rfOrder=32, authorNames=Wang WC, Yin WQ, journalName=Soft Science of Health, refType=null, unstructuredReference=Wang WC, Yin WQ. Analysis of the status quo and influencing factors of establishing health records among young migrants in China[J]. Soft Science of Health, 2023, 37(3): 85-89., articleTitle=Analysis of the status quo and influencing factors of establishing health records among young migrants in China, refAbstract=null), Reference(id=1240986278112587810, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, doi=null, pmid=null, pmcid=null, year=2018, volume=3, issue=null, pageStart=24, pageEnd=null, url=null, language=null, rfNumber=[18], rfOrder=33, authorNames=Su LN, Sun L, Xu LZ, journalName=Glob Health Res Policy, refType=null, unstructuredReference=Su LN, Sun L, Xu LZ. Review on the prevalence, risk factors and disease Management of Hypertension among floating population in China during 1990-2016[J]. Glob Health Res Policy, 2018, 3: 24., articleTitle=Review on the prevalence, risk factors and disease Management of Hypertension among floating population in China during 1990-2016, refAbstract=null)], funds=[Fund(id=1240986270327960469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, awardId=71974049; 71673073; 72274047, language=CN, fundingSource=国家自然科学基金项目(71974049; 71673073; 72274047), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240986256759386416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, xref=null, ext=[AuthorCompanyExt(id=1240986256767775027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, companyId=1240986256759386416, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081, China), AuthorCompanyExt(id=1240986256776163634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, companyId=1240986256759386416, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨 150081)])], figs=[ArticleFig(id=1240986265252852436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Figure 1, caption=The 1:1 nearest neighbor matching balance test results for hypertensive patients, figureFileSmall=4TlFupOwagXRauZMU/KLVQ==, figureFileBig=ZYzGG6NthW260yNmoTTUbg==, tableContent=null), ArticleFig(id=1240986265500316381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=图1, caption=高血压患者一对一匹配平衡性检验结果, figureFileSmall=4TlFupOwagXRauZMU/KLVQ==, figureFileBig=ZYzGG6NthW260yNmoTTUbg==, tableContent=null), ArticleFig(id=1240986265798111978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Figure 2, caption=The 1:1 nearest neighbor matching balance test results for type 2 diabetes, figureFileSmall=XYCgksq8qlu+wzoZnN29ng==, figureFileBig=M2a4TQEkK/HTEU8Z8y3KGw==, tableContent=null), ArticleFig(id=1240986266024604406, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=图2, caption=2型糖尿病患者一对一匹配平衡性检验结果, figureFileSmall=XYCgksq8qlu+wzoZnN29ng==, figureFileBig=M2a4TQEkK/HTEU8Z8y3KGw==, tableContent=null), ArticleFig(id=1240986266179793662, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Figure 3, caption=The 1:1 nearest neighbor matching balance test results for patients with two diseases, figureFileSmall=Etl3+IvDsI6rCxedzkp9KQ==, figureFileBig=SmzUXRt7tOr0h8wkSjWfbg==, tableContent=null), ArticleFig(id=1240986266389508874, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=图3, caption=两病共患者一对一匹配平衡性检验结果, figureFileSmall=Etl3+IvDsI6rCxedzkp9KQ==, figureFileBig=SmzUXRt7tOr0h8wkSjWfbg==, tableContent=null), ArticleFig(id=1240986266670527248, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 1, caption=

Variable selection and interpretation

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型变量赋值
被解释变量接受健康管理服务0=没有接受过，1=接受过
核心解释变量建立健康档案0=未建立/不清楚，1=已建立
人口特征性别1=男性，2=女性
民族0=少数民族，1=汉族
年龄（岁）1=30～44，2=45～59
劳动合同类型1=有固定期限，2=其他
家庭特征婚姻状况0=单身，1=非单身
流动时长（年）1=5及以下，2=5以上
流动原因1=经济原因，2=社会原因及其他
健康与公共服务接受健康教育0=未接受，1=至少接受1种
听说过“国家基本公共卫生服务项目”0=没听说过，1=听说过
自评健康0=不健康，1=健康/基本健康
居住地到最近医疗服务机构所需时间（min）1=≤15，2=15以上
地区变量地区固定效应1=东部，2=中部，3=西部
), ArticleFig(id=1240986266938962715, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表1, caption=

变量选取及释义

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类型变量赋值
被解释变量接受健康管理服务0=没有接受过，1=接受过
核心解释变量建立健康档案0=未建立/不清楚，1=已建立
人口特征性别1=男性，2=女性
民族0=少数民族，1=汉族
年龄（岁）1=30～44，2=45～59
劳动合同类型1=有固定期限，2=其他
家庭特征婚姻状况0=单身，1=非单身
流动时长（年）1=5及以下，2=5以上
流动原因1=经济原因，2=社会原因及其他
健康与公共服务接受健康教育0=未接受，1=至少接受1种
听说过“国家基本公共卫生服务项目”0=没听说过，1=听说过
自评健康0=不健康，1=健康/基本健康
居住地到最近医疗服务机构所需时间（min）1=≤15，2=15以上
地区变量地区固定效应1=东部，2=中部，3=西部
), ArticleFig(id=1240986267157066538, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 2, caption=

Basic information on survey respondents ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高血压患者2型糖尿病患者同时患有高血压和2型糖尿病者
是否接受健康管理是否接受健康管理是否接受健康管理
接受未接受接受未接受接受未接受
健康档案建立情况
未建立/不清楚747(21.16）2 783(78.84)109(18.08)494(81.92)60(18.46)265(81.54)
建立979(63.78）556(36.22)151(61.38)95(38.52)110(72.37)42(27.63)
性别
男1 006(32.85)2 056(67.15)152(28.36)384(71.64)91(32.38)190(67.62)
女750(36.89)1 283(63.11)108(34.50)205(65.50)79(40.31)117(59.69)
民族
少数民族170(39.35)262(60.65)31(32.63)64(67.37)23(46.00）27(54.00)
汉族1 556(33.59)3 077(66.41)229(30.37)525(69.63)147(34.43)280(65.57)
年龄（岁）
30～44557(31.54)1 209(68.46)79(26.25)222(73.75)49(31.82)105(68.18)
45～591 169(35.43)2 130(64.57)181(33.03)367(66.97)121(37.46)202(62.54)
劳动合同类型
有固定期限281(37.57)467(62.43)43(33.09)67(60.91)23(34.85)43(65.15)
其他1 445(33.47)2 872(66.53)221(29.91)518(70.09)147(35.77)264(64.23)
婚姻状况
单身88(33.98)171(66.02）21(45.65)25(54.35)9(33.33)18(66.67)
非单身1 638(34.08)3 168(65.92)239(29.76)564(70.24)161(35.78)289(64.22)
流动时长（年）
≤5631(35.83)1 130(64.17)101(35.44)184(64.56)44(28.57)110(71.43)
>51 095(33.14)2 209(66.86)129(24.16)405(75.84)126(39.01)197(51.70)
流动原因
经济原因1 444(33.22)2 903(66.78)211(29.97)493(70.03)135(35.34)247(64.66)
社会原因及其他282(39.28)436(60.72)49(33.79)96(66.21)35(36.84)60(63.16)
是否接受健康教育
未接受299(18.49)1 318(81.51)23(9.35)223(90.65)24(17.02)117(82.98)
至少接受1种1 427(41.39)2 021(58.61)237(39.30)366(60.70)146(43.45)190(56.55)
是否听说过“国家基本公共卫生服务项目”
未听说419(18.79)1 811(81.21)48(13.64)304(86.36)30(15.63)162(84.37)
听说过1 307(46.10)1 528(53.90)212(42.66)285(57.34)140(49.12)145(50.88)
自评健康
不健康188(27.89)486(72.11)46(27.06)124(72.94)49(32.45)102(67.55)
健康/基本健康1 538(35.03)2 853(64.97)214(31.52)465(68.48)121(37.12)205(62.88)
居住地到最近医疗服务
机构所需时间（min）
≤151 460(34.79)2 737(65.21)211(30.94)471(69.06)145(37.37)243(62.63)
>15602(69.35)266(30.65)49(29.34)118(70.66)25(28.09)64(71.91)
), ArticleFig(id=1240986267337421615, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表2, caption=

调查对象基本情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高血压患者2型糖尿病患者同时患有高血压和2型糖尿病者
是否接受健康管理是否接受健康管理是否接受健康管理
接受未接受接受未接受接受未接受
健康档案建立情况
未建立/不清楚747(21.16）2 783(78.84)109(18.08)494(81.92)60(18.46)265(81.54)
建立979(63.78）556(36.22)151(61.38)95(38.52)110(72.37)42(27.63)
性别
男1 006(32.85)2 056(67.15)152(28.36)384(71.64)91(32.38)190(67.62)
女750(36.89)1 283(63.11)108(34.50)205(65.50)79(40.31)117(59.69)
民族
少数民族170(39.35)262(60.65)31(32.63)64(67.37)23(46.00）27(54.00)
汉族1 556(33.59)3 077(66.41)229(30.37)525(69.63)147(34.43)280(65.57)
年龄（岁）
30～44557(31.54)1 209(68.46)79(26.25)222(73.75)49(31.82)105(68.18)
45～591 169(35.43)2 130(64.57)181(33.03)367(66.97)121(37.46)202(62.54)
劳动合同类型
有固定期限281(37.57)467(62.43)43(33.09)67(60.91)23(34.85)43(65.15)
其他1 445(33.47)2 872(66.53)221(29.91)518(70.09)147(35.77)264(64.23)
婚姻状况
单身88(33.98)171(66.02）21(45.65)25(54.35)9(33.33)18(66.67)
非单身1 638(34.08)3 168(65.92)239(29.76)564(70.24)161(35.78)289(64.22)
流动时长（年）
≤5631(35.83)1 130(64.17)101(35.44)184(64.56)44(28.57)110(71.43)
>51 095(33.14)2 209(66.86)129(24.16)405(75.84)126(39.01)197(51.70)
流动原因
经济原因1 444(33.22)2 903(66.78)211(29.97)493(70.03)135(35.34)247(64.66)
社会原因及其他282(39.28)436(60.72)49(33.79)96(66.21)35(36.84)60(63.16)
是否接受健康教育
未接受299(18.49)1 318(81.51)23(9.35)223(90.65)24(17.02)117(82.98)
至少接受1种1 427(41.39)2 021(58.61)237(39.30)366(60.70)146(43.45)190(56.55)
是否听说过“国家基本公共卫生服务项目”
未听说419(18.79)1 811(81.21)48(13.64)304(86.36)30(15.63)162(84.37)
听说过1 307(46.10)1 528(53.90)212(42.66)285(57.34)140(49.12)145(50.88)
自评健康
不健康188(27.89)486(72.11)46(27.06)124(72.94)49(32.45)102(67.55)
健康/基本健康1 538(35.03)2 853(64.97)214(31.52)465(68.48)121(37.12)205(62.88)
居住地到最近医疗服务
机构所需时间（min）
≤151 460(34.79)2 737(65.21)211(30.94)471(69.06)145(37.37)243(62.63)
>15602(69.35)266(30.65)49(29.34)118(70.66)25(28.09)64(71.91)
), ArticleFig(id=1240986267484222269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 3, caption=

Probit analysis of the effects of various factors on the acceptance of health management services by young and middle-aged migrant patients with chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
系数标准误P值系数标准误P值系数标准误P值
是否建立健康档案0.9400.046<0.0010.9050.114<0.0011.3330.154<0.001
性别0.0640.0420.1300.2000.1090.0390.4140.0050.011
年龄0.1730.042<0.0010.2030.1080.0490.0950.1490.529
民族-0.1750.0690.0120.1090.1600.494-0.2770.2220.212
劳动合同类型-0.0530.0560.338-0.2740.1470.0640.0430.2010.629
婚姻状况0.0380.0910.671-0.3920.2160.0030.0140.3030.964
流动时长-0.1040.0410.011-0.1670.1060.0360.1940.1480.191
流动原因0.1050.0590.0290.0670.1400.630-0.2750.1880.017
是否接受过健康教育0.3590.047<0.0010.6910.136<0.0010.2130.1700.023
是否听说过国家基本0.2880.046<0.0010.3680.1190.0020.4140.163<0.001
公共卫生服务项目
自评健康0.1880.060<0.0010.1460.1310.0520.2110.1540.044
居住地到最近医疗服务-0.1030.0530.0490.0840.1290.512-0.1260.1830.492
机构所需时间
地区固定效应控制
), ArticleFig(id=1240986267731686209, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表3, caption=

各种因素对中青年流动人口慢性病患者接受健康管理服务影响的Probit分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
系数标准误P值系数标准误P值系数标准误P值
是否建立健康档案0.9400.046<0.0010.9050.114<0.0011.3330.154<0.001
性别0.0640.0420.1300.2000.1090.0390.4140.0050.011
年龄0.1730.042<0.0010.2030.1080.0490.0950.1490.529
民族-0.1750.0690.0120.1090.1600.494-0.2770.2220.212
劳动合同类型-0.0530.0560.338-0.2740.1470.0640.0430.2010.629
婚姻状况0.0380.0910.671-0.3920.2160.0030.0140.3030.964
流动时长-0.1040.0410.011-0.1670.1060.0360.1940.1480.191
流动原因0.1050.0590.0290.0670.1400.630-0.2750.1880.017
是否接受过健康教育0.3590.047<0.0010.6910.136<0.0010.2130.1700.023
是否听说过国家基本0.2880.046<0.0010.3680.1190.0020.4140.163<0.001
公共卫生服务项目
自评健康0.1880.060<0.0010.1460.1310.0520.2110.1540.044
居住地到最近医疗服务-0.1030.0530.0490.0840.1290.512-0.1260.1830.492
机构所需时间
地区固定效应控制
), ArticleFig(id=1240986268067230541, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 4, caption=

The results of propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
患病类型匹配方法处理组控制组ATT标准差T统计量
高血压一对一匹配0.6380.2860.3520.01318.67
半径匹配0.6370.2870.3500.01621.37
核匹配0.6370.2830.3550.01622.03
2型糖尿病一对一匹配0.6140.2660.3480.0536.60
半径匹配0.6120.2670.3440.0428.27
核匹配0.6140.2650.3490.0408.75
两病共患一对一匹配0.7230.1840.5390.0687.91
半径匹配0.7080.2110.4970.0559.05
核匹配0.7230.2180.5050.0129.86
), ArticleFig(id=1240986268646044506, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表4, caption=

倾向得分匹配估计结果

, figureFileSmall=null, figureFileBig=null, tableContent=
患病类型匹配方法处理组控制组ATT标准差T统计量
高血压一对一匹配0.6380.2860.3520.01318.67
半径匹配0.6370.2870.3500.01621.37
核匹配0.6370.2830.3550.01622.03
2型糖尿病一对一匹配0.6140.2660.3480.0536.60
半径匹配0.6120.2670.3440.0428.27
核匹配0.6140.2650.3490.0408.75
两病共患一对一匹配0.7230.1840.5390.0687.91
半径匹配0.7080.2110.4970.0559.05
核匹配0.7230.2180.5050.0129.86
), ArticleFig(id=1240986268797039457, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 5, caption=

Differences in the impact of health records on the uptake of health management services by hypertensive patients in different young and middle-aged mobile populations

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型 II
中年		模型 III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.376***
（0.023）		0.325***
（0.019）		0.352***
（0.016）		0.305***
（0.040）		0.259***
（0.031）		0.359***
（0.017）
其他控制变量控制
地区固定效应控制
), ArticleFig(id=1240986269354881899, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表5, caption=

健康档案对不同中青年流动人群高血压患者接受健康管理服务影响的差异

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型 II
中年		模型 III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.376***
（0.023）		0.325***
（0.019）		0.352***
（0.016）		0.305***
（0.040）		0.259***
（0.031）		0.359***
（0.017）
其他控制变量控制
地区固定效应控制
), ArticleFig(id=1240986269489099636, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 6, caption=

Differences in the impact of health records on the uptake of follow-up services for type 2 diabetes mellitus in different young and middle-aged mobile populations

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型II
中年		模型III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.269***
（0.059）		0.360***
（0.042）		0.334***
(0.038)		0.296***
(0.079)		0.234***
（0.073）		0.338***
(0.040)
其他控制变量控制
地区固定效应控制
), ArticleFig(id=1240986269564597117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表6, caption=

健康档案对不同中青年流动人群2型糖尿病患者接受随访服务影响的差异

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型II
中年		模型III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.269***
（0.059）		0.360***
（0.042）		0.334***
(0.038)		0.296***
(0.079)		0.234***
（0.073）		0.338***
(0.040)
其他控制变量控制
地区固定效应控制
), ArticleFig(id=1240986269690426245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=EN, label=Table 7, caption=

Differences in the impact of health records on the acceptance of health management services for patients with two co-morbidities in different young and middle-aged mobile populations

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型II
中年		模型III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.414***
（0.073）		0.473***
（0.055）		0.451***
(0.054)		0.471***
(0.077)		0.281*
(0.130)		0.475***
(0.047)
其他控制变量控制
地区固定效应控制
), ArticleFig(id=1240986269979833228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972419620458649, language=CN, label=表7, caption=

健康档案对不同中青年流动人群两病共患者接受健康管理服务影响的差异

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年龄自评健康情况健康教育情况
模型I
青年		模型II
中年		模型III
健康		模型IV
不健康		模型V
未接受		模型VI
接受
建立健康档案0.414***
（0.073）		0.473***
（0.055）		0.451***
(0.054)		0.471***
(0.077)		0.281*
(0.130)		0.475***
(0.047)
其他控制变量控制
地区固定效应控制
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健康档案建立对中青年流动人口慢性病患者健康管理服务利用的影响——以高血压和2型糖尿病为例
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王楠 , 吴群红 , 冯亚杰 , 张环宇 , 刘俊萍 , 刘智新 , 刘伟 , 梁立波
现代预防医学 | 卫生政策与管理 2024,51(9): 1630-1636
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现代预防医学 | 卫生政策与管理 2024, 51(9): 1630-1636
健康档案建立对中青年流动人口慢性病患者健康管理服务利用的影响——以高血压和2型糖尿病为例
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王楠, 吴群红, 冯亚杰, 张环宇, 刘俊萍, 刘智新, 刘伟, 梁立波
作者信息
  • 哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨 150081

    • 王楠（1999—），女，硕士研究生，研究方向：人群健康研究工作

通讯作者:

梁立波，E-mail:
The effect of the establishment of health records on the utilization of health management services for patients with chronic diseases in young and middle-aged floating population: a case study of hypertension and type 2 diabetes mellitus
Nan WANG, Qun-hong WU, Ya-jie FENG, Huan-yu ZHANG, Jun-ping LIU, Zhi-xin LIU, Wei LIU, Li-bo LIANG
Affiliations
  • School of Health Management, Harbin Medical University, Harbin, Heilongjiang 150081, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202310179
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摘要
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目的

了解中青年流动人口高血压和2型糖尿病患者建立健康档案对其接受健康管理服务的影响，为提高健康管理服务利用率，实现基本公共卫生服务均等化提供参考。

方法

基于2017年全国流动人口卫生计生动态监测数据中6 391名30～59岁中青年慢性病患者人口特征、家庭特征、健康与公共服务特征资料，运用Probit模型及倾向得分匹配法分析健康档案对中青年流动人口高血压及2型糖尿病患者接受健康管理服务的影响。

结果

Probit模型结果显示，高血压患者、2型糖尿病患者及两病共患者建立健康档案的系数分别为0.940、0.905、1.333，且均在1%水平上显著，即建立健康档案对中青年流动人口慢性病患者接受健康管理服务有正向作用。纠正模型内生性问题后，这一结果仍然稳健。异质性分析发现建立健康档案对接受健康管理服务存在年龄、自评健康及健康教育差异。

结论

建立健康档案对中青年流动人口慢性病患者接受健康管理服务有正向影响。今后应关注中青年流动人口高血压和2型糖尿病患者的基本公共卫生服务需求，针对不同特征的患者开展健康教育宣传工作，提高基本公共卫生服务知晓率与使用率。

流动人口  /  中青年慢性病患者  /  健康档案  /  健康管理服务
Objective

To understand the effect of establishing health records on the acceptance of health management services in young and middle-aged floating population with hypertension and type 2 diabetes, and to provide references for improving the utilization rate of health management services and realizing the equalization of basic public health services.

Methods

Based on the population characteristics, family characteristics, health and public service characteristics of 6 391 young and middle-aged patients with chronic diseases aged 30 to 59 years old in 2017, Probit model and tendency score matching method were used to analyze the effect of health files on the acceptance of health management services in young and middle-aged floating population with hypertension and type 2 diabetes.

Results

The results of Probit model showed that the coefficients of establishing health records for hypertension patients, type 2 diabetes patients, and patients with both diseases were 0.940, 0.905, and 1.333, respectively, and they were all significant at 1% level, indicating that the establishment of health records had a positive effect on the health management services of young and middle-aged floating population with chronic diseases. After correcting the endogenous problems of the model, the result remained robust. Heterogeneity analysis found that there were differences in age, self-rated health, and health education in the establishment of health records.

Conclusion

The establishment of health records has a positive impact on the acceptance of health management services for patients with chronic diseases in young and middle-aged floating population. In the future, we should pay attention to the basic public health service needs of patients with hypertension and type 2 diabetes in young and middle-aged floating population, carry out health education and publicity work for patients with different characteristics, and improve the awareness and utilization rate of basic public health services.

Floating population  /  Young and middle-aged patients with chronic diseases  /  Health records  /  Health management services
王楠, 吴群红, 冯亚杰, 张环宇, 刘俊萍, 刘智新, 刘伟, 梁立波. 健康档案建立对中青年流动人口慢性病患者健康管理服务利用的影响——以高血压和2型糖尿病为例. 现代预防医学, 2024 , 51 (9) : 1630 -1636 . DOI: 10.20043/j.cnki.MPM.202310179
Nan WANG, Qun-hong WU, Ya-jie FENG, Huan-yu ZHANG, Jun-ping LIU, Zhi-xin LIU, Wei LIU, Li-bo LIANG. The effect of the establishment of health records on the utilization of health management services for patients with chronic diseases in young and middle-aged floating population: a case study of hypertension and type 2 diabetes mellitus[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1630 -1636 . DOI: 10.20043/j.cnki.MPM.202310179
正文
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近年来，不良饮食习惯、吸烟、饮酒和缺乏体育锻炼等行为流行，导致我国慢性病患者人数不断增加且呈年轻化发展趋势[1]。慢性病患病率增加给人们的生命带来危害，《中国居民营养与慢性病状况报告（2020年）》显示，我国因慢性病导致的死亡占总死亡的88.5%。因此，中国加强了对慢性病患者，特别是对高血压和2型糖尿病患者的健康管理。但有研究表明，流动人口慢性病患者基本公共卫生服务利用率仅为36.4%，该群体已成为实现基本公共卫生服务均等化的重、难点人群[2]。健康档案是开展健康管理的基础，完善的健康档案记录了个人的健康状况和相关信息，为社区卫生服务机构制定医疗服务计划提供了基本资料，有利于对慢性病患者开展追踪式健康管理服务，对推进健康中国建设具有重要意义。为此，本研究通过了解中青年流动人口高血压和2型糖尿病患者建立健康档案对其接受健康管理服务的影响，为提高此类人群健康管理服务利用率，实现基本公共卫生服务均等化提供参考。
1　对象与方法
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1.1　研究对象
资料来源于2017年全国流动人口卫生计生动态监测调查流动人口问卷（A）监测数据，调查采用分层、多阶段、与规模成比例的概率抽样法在全国31个省（区、市）（除香港、澳门、台湾地区）及新疆生产建设兵团流动人口较为集中的地区进行抽样。该问卷仅调查高血压和2型糖尿病患者是否接受慢性病健康管理服务，因此选择以上两种疾病进行分析。本研究依据2012年世界卫生组织提出的年龄分类标准进行分组：青年（≤44岁）、中年（45～59岁）[3]，但由于30岁以下人群多为1型糖尿病患者[4]，故选取流入本地6个月及以上且年龄在30～59岁的高血压和2型糖尿病患者，最终获得实际调查的有效样本为6 391人。
1.2　变量选取与描述
本文的被解释变量为“过去一年，您是否接受过本地社区卫生服务中心（站）/乡镇卫生院免费提供的针对上述疾病的随访评估、健康体检等服务？”，核心解释变量为建立健康档案。选取性别、民族、年龄、婚姻状况等控制变量纳入回归模型中。见表1。
1.3　研究方法
由于被解释变量为二值选择变量，Probit模型能够通过结果对二值选择问题进行全方位的阐释，故采用Probit模型探析建立健康档案对中青年流动人口慢性病患者接受健康管理服务的影响，Probit模型设定如下：
其中，i表示个体，k表示地区，Yi表示接受健康管理服务情况，Ni表示健康档案建立情况，Xi表示其他控制变量，μk表示地区固定效应，μi表示随机干扰项，β0为截距项，β1和β2分别代表变量的系数。由于建立健康档案与接受健康管理服务情况之间可能存在混杂因素干扰，故本研究采用倾向得分匹配法计算平均处理效应值（average treatment effect on the treated，ATT），进一步验证建立健康档案对该群体接受健康管理服务的影响，ATT表达式如下：
其中，Ni=1表示建立健康档案，为处理组；Ni=0，表示未建立，为对照组；Y1i和Y0i分别表示处理组与对照组评估指标结果。
本研究采用stata 15.0软件进行统计学分析，检验水准α=0.05[5]。
2　结果
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2.1　调查对象基本情况
本研究共纳入6 391名研究对象，高血压患者5 065人（4.86%），2型糖尿病患者849人（0.81%），同时患有以上两种慢性病者477人（0.46%），其中33.73%的慢性病患者接受过健康管理服务。见表2。
2.2　建立健康档案对中青年流动人口慢性病患者接受健康管理服务影响
建立健康档案对中青年流动人口高血压患者（模型1）、2型糖尿病患者（模型2）及两病共患者（模型3）接受健康管理服务影响的Probit结果显示，建立健康档案对中青年流动人口慢性病患者接受健康管理服务均有显著正向作用。见表3。
2.3　倾向得分匹配估计结果
接受健康管理服务不是一个随机行为，而是慢性病患者根据身体情况和对卫生政策的了解做出的选择，且年龄、性别、流动时长等因素均会对健康管理服务利用产生影响。因此，本研究采用倾向得分匹配法减少数据偏差和混杂因素干扰，探析结果的稳健性。利用Probit模型计算匹配得分，采用一对一匹配、半径匹配和核匹配方法进行匹配。一对一匹配后大部分控制变量的标准化偏差较匹配前明显减小，且标准化偏差值小于10%，匹配结果可以接受，见图1、2、3。
ATT值如表4所示。高血压患者匹配后对应T值为18.67、21.37、22.03；2型糖尿病患者匹配后对应T值为6.60、8.27、8.75；同时患有以上两种疾病者匹配后对应T值为7.91、9.05、9.86。以上T值均大于1.96的临界值，结果均具有显著性，证明了建立健康档案对中青年流动人口慢性病患者接受健康管理服务具有显著影响[6]。
2.4　异质性分析
本部分进一步探究健康档案对不同中青年流动人口慢性病患者健康管理服务利用影响的群体性差异。表5模型Ⅰ～模型Ⅵ结果显示，青年、自评健康、接受过健康教育的高血压患者健康管理服务使用情况受建立健康档案的影响较大。
表6模型Ⅰ～模型Ⅵ结果显示，中年、自评健康、接受过健康教育的2型糖尿病者健康管理服务使用情况受建立健康档案的影响较大。
表7模型Ⅰ～模型Ⅵ结果显示，中年、自评不健康、接受过健康教育的两病共患者健康管理服务使用情况受建立健康档案的影响较大。
3　讨论
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3.1　中青年流动人口慢性病患者健康管理服务利用率低
本研究结果显示，中青年流动人口慢性病患者健康管理服务利用率不到34%，低于老年流动人口慢性病患者（46.5%）、非流动人口高血压患者（70.31%）及2型糖尿病患者（65.57%）的健康管理服务利用率[7-8]，更与实现“高血压、糖尿病患者管理干预全覆盖”的健康中国目标存在明显差距。这可能与流动人口多为钟摆式循环流动或多城市辗转流动[9]，给社区卫生服务人员追踪随访工作造成困难有关[10]。加之当前中国流动人口以初中学历为主，健康意识差，获得健康知识和培养健康信念越加困难，缺少健康管理服务利用的主动性[11]。此外，中青年流动群体多为青壮劳动力，其健康问题常被个人、社会忽视，导致其健康管理服务利用率低。因此，在推广慢性病健康管理服务过程中，应重点关注中青年流动人口，以期实现基本公共卫生服务均等化。
3.2　建立健康档案对中青年流动人口慢性病患者接受健康管理服务有促进作用
Probit模型结果显示，建立健康档案与中青年流动人口慢性病患者接受健康管理服务呈正相关。一方面，建立健康档案利于扩大健康管理服务的辐射范围及影响力[12]，改变患者就医态度与行为，从而提高健康管理服务利用率[2]。另一方面，基层医疗卫生机构可以通过健康档案中的数据发现、评价患者当前的身体状况，并通过健康监测和分析为其提供个性化的健康管理服务，促使患者在社区医生的督导下定期进行慢性病规范化管理[13]。但有研究指出，流动人口健康档案的建立率较低，并且没有随流动时间的增长而相应增加[14]。为此，各地政府应加强基本公共卫生服务宣传，并积极与大众媒体展开合作，提高居民建立健康档案的积极性。其次，应提高流动人口登记的时效性并开展数字化健康服务，实现健康档案在全国范围内互联互通，避免重复建档造成的资源浪费与心理倦怠。
3.3　建立健康档案对中青年流动人口慢性病患者接受健康管理服务的差异化影响
首先，年龄存在差异。患2型糖尿病和两病共患的流动群体中，中年所受影响大于青年。一是因为多数青年患者对疾病抱有侥幸心理且病耻感较重，这种负性心理直接导致其接受慢病管理情况不佳[15]。二是年龄越大，居民对健康情况就越重视，因此患有2型糖尿病和两病共患的中年流动群体更愿意建立健康档案与接受慢病管理。但中年流动人口高血压患者所受影响略小于青年高血压患者。这可能与近年来生活方式改变导致高血压低龄化有关[16]。加之我国在2018年提出电子健康档案向个人开放的政策，青年高血压患者更倾向于建立电子健康档案。
其次，自评健康情况存在差异。在仅患高血压和仅患2型糖尿病的中青年流动人口中，自评健康者所受影响大于自评不健康者。这可能是因为自评不健康者对自身患病事实有抗拒心理，主观意愿及生理原因限制其到社区医院接受健康管理服务[8]。但相比自评健康的两病共患群体，自评不健康的此类群体所受影响更大。这可能是因为此类人群更注重疾病控制，质疑或抵触初级医疗卫生服务机构，更倾向于到大型公立医院就诊[8]。
最后，健康教育情况存在差异。相较于未接受过健康教育的中青年流动人口慢性病患者，接受过健康教育者所受影响较大。这主要是因为健康教育在流动人口健康档案建立方面起到了积极的促进作用[17]。综上，不仅要保障健康档案的数量和质量，还要鼓励居民使用健康档案。针对不同年龄和患病类型采取不同的宣教和健康档案形式，引导慢性病患者积极建立符合其使用习惯的档案。还要重点关注健康情况较差的中青年流动人口，提高其健康管理依从性，从患方角度保障健康档案使用质量[18]。还要增加社区卫生专业人员数量，提高人员服务能力，完善服务机构设置，从卫生服务供方角度提高健康档案使用水平。最后，应将健康档案知识融入“互联网+健康教育”体系，提高中青年流动人口自主使用健康档案完成相关基本公共卫生服务的意识。
基金
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  • 国家自然科学基金项目(71974049; 71673073; 72274047)
文献
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202310179
  • 接收时间：2023-10-14
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-10-14
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国家自然科学基金项目(71974049; 71673073; 72274047)
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    哈尔滨医科大学卫生管理学院，黑龙江 哈尔滨 150081

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梁立波，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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