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Article(id=1241025210447614642, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407378, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1721232000000, receivedDateStr=2024-07-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773813067304, onlineDateStr=2026-03-18, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773813067304, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773813067304, creator=13701087609, updateTime=1773813067304, updator=13701087609, issue=Issue{id=1241025201983508979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773813065285, creator=13701087609, updateTime=1773815493878, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035388320543403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035388320543404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1278, endPage=1283, ext={EN=ArticleExt(id=1241025210745410239, articleId=1241025210447614642, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The relationship between dental care-seeking behavior and oral health-related quality of life among the elderly and the moderating role of income, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between oral health-related quality of life (OHRQoL) and dental care-seeking behavior among the elderly in Sichuan Province, while analyzing the impact of income on this relationship.

Methods

A total of 744 elderly individuals aged 65 to 74 years from Sichuan Province were included in this study through multi-stage stratified random sampling during the Fourth National Oral Health Epidemiological Survey conducted from 2015 to 2016. A questionnaire was used to assess the participants’ income levels, dental care-seeking behavior, and OHRQoL. Stratified logistic regression was employed to examine the relationship between dental care-seeking behavior and OHRQoL, as well as the moderating effect of income.

Results

Among the 744 participants, 552 (74.2%) reported engaging in dental care-seeking behavior. Lower overall (β=-0.040, P < 0.001), functional (β=-0.028,P=0.002), pain-related (β=-0.037, P < 0.001), and psychological (β=-0.029, P=0.002) dimensions of OHRQoL were associated with an increased likelihood of dental care-seeking among the elderly. Additionally, income had a positive moderating effect only on the relationship between oral health-related psychological discomfort and dental care-seeking behavior; specifically, lower income was associated with a weaker correlation between psychological discomfort related to oral health and dental care-seeking behavior (β=-0.007,P=0.039).

Conclusion

The utilization of oral health services among the elderly in Sichuan Province is suboptimal, with poor OHRQoL being a primary driving factor for dental care-seeking behavior. High income only facilitates dental visits when oral health issues lead to psychological discomfort. Public health efforts targeting oral health among the elderly should focus on updating their perceptions of oral health and addressing the psychological impacts associated with oral health.

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目的

探讨口腔健康相关生活质量（oral health-related quality of life， OHRQoL）与四川省老年人牙科就医行为间的关系，并分析收入在其中的影响。

方法

在2015—2016年第四次全国口腔健康流行病学调查中，通过多阶段分层随机抽样纳入744名四川省65～74岁老年人。通过问卷法调查样本人群的收入水平、就医情况和OHRQoL，采用分层逻辑回归检验就医行为与OHRQoL的关系以及收入在其中的调节作用。

结果

744名调查对象中，552人（74.2%）报告了牙科就医行为。OHRQoL的总体（β=-0.040， P<0.001）及功能（β=-0.028， P=0.002）、疼痛（β=-0.037， P<0.001）、心理（β=-0.029， P=0.002）维度得分较低均与老年人牙科就医概率增加有关。而收入仅对口腔健康相关心理不适和牙科就医行为间的关系表现出正向促进作用，收入越低的老年人口腔健康相关心理不适与牙科就医行为的关联性越弱（β=-0.007，P=0.039）。

结论

四川省老年人口腔卫生服务利用情况不佳，较差的OHRQoL是牙科就医行为主要驱动因素，高收入仅在口腔健康问题导致心理不适时促进牙科就诊。在针对老年人的口腔公共卫生服务中，需要将工作重点更多地放在更新老年人群的口腔健康观念上，同时应关注口腔健康相关的心理影响。

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胡涛，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=GF6pzbFt1ja7+d7xOdE0Fg==, magXml=+ulLyNUNahFdJduUXyO81A==, pdfUrl=null, pdf=jmEMOy/hjpTl6EVXNKRBjA==, pdfFileSize=1166356, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=he2rDiwDDJ2P5+HNuHkSmw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=eGsfgUE6gPSAmFkk1qt6sw==, mapNumber=null, authorCompany=null, fund=null, authors=

蒋菡（1998—），女，博士，无技术职称，研究方向：口腔流行病学

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蒋菡（1998—），女，博士，无技术职称，研究方向：口腔流行病学

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蒋菡（1998—），女，博士，无技术职称，研究方向：口腔流行病学

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BMC Public Health, 2024, 24: 803., articleTitle=Social participation, subjective well- being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults, refAbstract=null)], funds=[Fund(id=1241025220107096267, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, awardId=2023YFC3605600, language=CN, fundingSource=国家重点研发计划项目(2023YFC3605600), fundOrder=null, country=null), Fund(id=1241025220249702611, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, awardId=72104162, language=CN, fundingSource=国家自然科学基金项目(72104162), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241025212393771795, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, xref=null, ext=[AuthorCompanyExt(id=1241025212402160404, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, companyId=1241025212393771795, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=National Center for Oral Medicine, National Clinical Research Center for Oral Diseases, Key Laboratory of Oral Disease Prevention and Treatment, Oral Medicine + Frontier Medical Innovation Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241025212406354709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, companyId=1241025212393771795, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔疾病防治全国重点实验室，口腔医学+前沿医学创新中心，四川大学华西口腔医院预防口腔科，四川 成都 610041)])], figs=[ArticleFig(id=1241025217418547286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=EN, label=Figure 1, caption=Moderating effect of income in the relationship between health-seeking behavior and OHRQoL in psychological function dimension, figureFileSmall=1bxxaRUmeZv84tOZ/Yka2Q==, figureFileBig=he2rDiwDDJ2P5+HNuHkSmw==, tableContent=null), ArticleFig(id=1241025218861387872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=CN, label=图1, caption=收入状况在心理不适维度OHRQoL与就医行为间的调节作用, figureFileSmall=1bxxaRUmeZv84tOZ/Yka2Q==, figureFileBig=he2rDiwDDJ2P5+HNuHkSmw==, tableContent=null), ArticleFig(id=1241025219129823346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=EN, label=Table 1, caption=

Basic information of all participants ［n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总计牙科就医行为P值χ2/Z值
有无
性别0.4430.590
男362(48.7)264(72.9)98(28.1)
女382(51.3)288(75.4)94(24.6)
教育水平0.0057.893
初中及以下641(86.2)464(72.4)177(27.6)
高中及以上103(13.8)88(85.4)15(14.6)
医疗保险0.1412.162
有724(97.3)540(74.6)184(25.4)
无20(2.7%)12(60.0)8(40.0)
吸烟习惯0.2531.308
有153(20.6)108(70.6)45(29.4)
无591(79.4)444(75.1)147(24.9)
饮酒习惯0.1142.504
有131(17.6)90(68.7)41(31.3)
无613(82.4)462(75.4)151(24.6)
其他慢性疾病0.0029.240
有500(67.2)388(77.6)112(22.4)
无244(32.8)164(67.2)80(32.8)
INR4.06(2.29, 6.77)4.63(2.54, 7.36)3.39(2.09, 5.65)0.0013.229
OHRQoL
总体水平50.98(44.42, 57.54)50.98(44.42, 56.23)53.61(47.05, 60.16)<0.001-4.621
功能限制49.12(43.22, 57.98)49.12(43.22, 57.98)52.08(46.17, 60.19)0.002-3.156
疼痛不适52.36(41.51, 59.59)48.74(41.51, 55.97)55.97(45.13, 59.58)<0.001-4.466
心理不适51.13(45.41, 56.84)51.13(45.41, 56,84)53.98(48.27, 59.69)<0.001-4.218
), ArticleFig(id=1241025219238875258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=CN, label=表1, caption=

调查对象基本情况［n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总计牙科就医行为P值χ2/Z值
有无
性别0.4430.590
男362(48.7)264(72.9)98(28.1)
女382(51.3)288(75.4)94(24.6)
教育水平0.0057.893
初中及以下641(86.2)464(72.4)177(27.6)
高中及以上103(13.8)88(85.4)15(14.6)
医疗保险0.1412.162
有724(97.3)540(74.6)184(25.4)
无20(2.7%)12(60.0)8(40.0)
吸烟习惯0.2531.308
有153(20.6)108(70.6)45(29.4)
无591(79.4)444(75.1)147(24.9)
饮酒习惯0.1142.504
有131(17.6)90(68.7)41(31.3)
无613(82.4)462(75.4)151(24.6)
其他慢性疾病0.0029.240
有500(67.2)388(77.6)112(22.4)
无244(32.8)164(67.2)80(32.8)
INR4.06(2.29, 6.77)4.63(2.54, 7.36)3.39(2.09, 5.65)0.0013.229
OHRQoL
总体水平50.98(44.42, 57.54)50.98(44.42, 56.23)53.61(47.05, 60.16)<0.001-4.621
功能限制49.12(43.22, 57.98)49.12(43.22, 57.98)52.08(46.17, 60.19)0.002-3.156
疼痛不适52.36(41.51, 59.59)48.74(41.51, 55.97)55.97(45.13, 59.58)<0.001-4.466
心理不适51.13(45.41, 56.84)51.13(45.41, 56,84)53.98(48.27, 59.69)<0.001-4.218
), ArticleFig(id=1241025219335344264, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=EN, label=Table 2, caption=

Correlations between OHRQoL, INR and health-seeking behavior

, figureFileSmall=null, figureFileBig=null, tableContent=
总体OHRQoL功能限制疼痛不适心理不适INR就医行为
总体OHRQoL1—————
功能限制0.835**1————
疼痛不适0.748**0.473**1———
心理不适0.726**0.420**0.357**1——
INR0.098**0.164**-0.0030.0191—
就医行为-0.170**-0.116**-0.164**-0.155**0.118**1
), ArticleFig(id=1241025219456979091, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=CN, label=表2, caption=

OHRQoL、INR、就医行为相关性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
总体OHRQoL功能限制疼痛不适心理不适INR就医行为
总体OHRQoL1—————
功能限制0.835**1————
疼痛不适0.748**0.473**1———
心理不适0.726**0.420**0.357**1——
INR0.098**0.164**-0.0030.0191—
就医行为-0.170**-0.116**-0.164**-0.155**0.118**1
), ArticleFig(id=1241025219582808223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=EN, label=Table 3, caption=

Moderating effect of income in the relationship between health-seeking behavior and OHRQoL in psychological function dimension

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量及参数第一层第二层第三层
βWaldχ2值βWaldχ2值βWaldχ2值
常数0.2550.3410.419
性别-0.1700.691-0.1020.239-0.0810.151
教育水平0.8798.557**0.6694.413*0.6434.084*
医疗保险0.4921.0730.4520.8830.4000.698
吸烟-0.0120.0030.0570.0540.0710.084
饮酒-0.2130.832-0.2791.3650.3131.707
慢性病0.5429.270**0.5158.081**0.5348.600**
心理不适-0.0299.290**-0.0402.541***
INR0.0686.748**0.09010.003**
心理不适*INR-0.0074.279*
R20.0440.0770.085
ΔR2-0.0330.008
), ArticleFig(id=1241025219712831659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=CN, label=表3, caption=

收入状况在心理不适维度OHRQoL与就医行为关系中的调节效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量及参数第一层第二层第三层
βWaldχ2值βWaldχ2值βWaldχ2值
常数0.2550.3410.419
性别-0.1700.691-0.1020.239-0.0810.151
教育水平0.8798.557**0.6694.413*0.6434.084*
医疗保险0.4921.0730.4520.8830.4000.698
吸烟-0.0120.0030.0570.0540.0710.084
饮酒-0.2130.832-0.2791.3650.3131.707
慢性病0.5429.270**0.5158.081**0.5348.600**
心理不适-0.0299.290**-0.0402.541***
INR0.0686.748**0.09010.003**
心理不适*INR-0.0074.279*
R20.0440.0770.085
ΔR2-0.0330.008
), ArticleFig(id=1241025219888992441, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=EN, label=Table 4, caption=

Moderating effect of income in the relationship between health-seeking behavior and OHRQoL in overall level, physical function dimension, and pain and discomfort dimension

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量及参数总体水平功能限制疼痛不适
βWaldχ2值βWaldχ2值βWaldχ2值
第一层
控制变量（同表3）
第二层
总体水平-0.04017.681***————
功能限制——-0.0289.578**——
疼痛不适————-0.03715.439***
INR0.0747.680**0.0767.882**0.0676.416*
R20.0930.0760.088
ΔR20.0490.0320.044
第三层
总体水平*INR-0.0053.191————
功能限制*INR——-0.0031.403——
疼痛不适*INR————-0.0020.521
R20.0990.0790.089
ΔR20.0010.030.001
), ArticleFig(id=1241025219993850050, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025210447614642, language=CN, label=表4, caption=

收入状况在OHRQoL总体水平、功能限制、疼痛不适维度水平与就医行为关系中的调节效应分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型变量及参数总体水平功能限制疼痛不适
βWaldχ2值βWaldχ2值βWaldχ2值
第一层
控制变量（同表3）
第二层
总体水平-0.04017.681***————
功能限制——-0.0289.578**——
疼痛不适————-0.03715.439***
INR0.0747.680**0.0767.882**0.0676.416*
R20.0930.0760.088
ΔR20.0490.0320.044
第三层
总体水平*INR-0.0053.191————
功能限制*INR——-0.0031.403——
疼痛不适*INR————-0.0020.521
R20.0990.0790.089
ΔR20.0010.030.001
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老年人牙科就医行为与口腔健康相关生活质量的关系及收入的调节作用
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蒋菡 , 卢妍蓓 , 陈柯昕 , 程立 , 蔡和 , 胡涛
现代预防医学 | 健康与社会行为 2025,52(7): 1278-1283
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现代预防医学 | 健康与社会行为 2025, 52(7): 1278-1283
老年人牙科就医行为与口腔健康相关生活质量的关系及收入的调节作用
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蒋菡, 卢妍蓓, 陈柯昕, 程立, 蔡和, 胡涛
作者信息
  • 国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔疾病防治全国重点实验室，口腔医学+前沿医学创新中心，四川大学华西口腔医院预防口腔科，四川 成都 610041

    • 蒋菡（1998—），女，博士，无技术职称，研究方向：口腔流行病学

通讯作者:

胡涛，E-mail:
The relationship between dental care-seeking behavior and oral health-related quality of life among the elderly and the moderating role of income
Han JIANG, Yan-bei LU, Ke-xin CHEN, Li CHENG, He CAI, Tao HU
Affiliations
  • National Center for Oral Medicine, National Clinical Research Center for Oral Diseases, Key Laboratory of Oral Disease Prevention and Treatment, Oral Medicine + Frontier Medical Innovation Center, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-04-10 doi: 10.20043/j.cnki.MPM.202407378
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摘要
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目的

探讨口腔健康相关生活质量（oral health-related quality of life， OHRQoL）与四川省老年人牙科就医行为间的关系，并分析收入在其中的影响。

方法

在2015—2016年第四次全国口腔健康流行病学调查中，通过多阶段分层随机抽样纳入744名四川省65～74岁老年人。通过问卷法调查样本人群的收入水平、就医情况和OHRQoL，采用分层逻辑回归检验就医行为与OHRQoL的关系以及收入在其中的调节作用。

结果

744名调查对象中，552人（74.2%）报告了牙科就医行为。OHRQoL的总体（β=-0.040， P<0.001）及功能（β=-0.028， P=0.002）、疼痛（β=-0.037， P<0.001）、心理（β=-0.029， P=0.002）维度得分较低均与老年人牙科就医概率增加有关。而收入仅对口腔健康相关心理不适和牙科就医行为间的关系表现出正向促进作用，收入越低的老年人口腔健康相关心理不适与牙科就医行为的关联性越弱（β=-0.007，P=0.039）。

结论

四川省老年人口腔卫生服务利用情况不佳，较差的OHRQoL是牙科就医行为主要驱动因素，高收入仅在口腔健康问题导致心理不适时促进牙科就诊。在针对老年人的口腔公共卫生服务中，需要将工作重点更多地放在更新老年人群的口腔健康观念上，同时应关注口腔健康相关的心理影响。

老年人  /  口腔保健  /  生活质量  /  诊室就诊  /  收入
Objective

To explore the relationship between oral health-related quality of life (OHRQoL) and dental care-seeking behavior among the elderly in Sichuan Province, while analyzing the impact of income on this relationship.

Methods

A total of 744 elderly individuals aged 65 to 74 years from Sichuan Province were included in this study through multi-stage stratified random sampling during the Fourth National Oral Health Epidemiological Survey conducted from 2015 to 2016. A questionnaire was used to assess the participants’ income levels, dental care-seeking behavior, and OHRQoL. Stratified logistic regression was employed to examine the relationship between dental care-seeking behavior and OHRQoL, as well as the moderating effect of income.

Results

Among the 744 participants, 552 (74.2%) reported engaging in dental care-seeking behavior. Lower overall (β=-0.040, P < 0.001), functional (β=-0.028,P=0.002), pain-related (β=-0.037, P < 0.001), and psychological (β=-0.029, P=0.002) dimensions of OHRQoL were associated with an increased likelihood of dental care-seeking among the elderly. Additionally, income had a positive moderating effect only on the relationship between oral health-related psychological discomfort and dental care-seeking behavior; specifically, lower income was associated with a weaker correlation between psychological discomfort related to oral health and dental care-seeking behavior (β=-0.007,P=0.039).

Conclusion

The utilization of oral health services among the elderly in Sichuan Province is suboptimal, with poor OHRQoL being a primary driving factor for dental care-seeking behavior. High income only facilitates dental visits when oral health issues lead to psychological discomfort. Public health efforts targeting oral health among the elderly should focus on updating their perceptions of oral health and addressing the psychological impacts associated with oral health.

Elderly  /  Oral health care  /  Quality of life  /  Dental visits  /  Income
蒋菡, 卢妍蓓, 陈柯昕, 程立, 蔡和, 胡涛. 老年人牙科就医行为与口腔健康相关生活质量的关系及收入的调节作用. 现代预防医学, 2025 , 52 (7) : 1278 -1283 . DOI: 10.20043/j.cnki.MPM.202407378
Han JIANG, Yan-bei LU, Ke-xin CHEN, Li CHENG, He CAI, Tao HU. The relationship between dental care-seeking behavior and oral health-related quality of life among the elderly and the moderating role of income[J]. Modern Preventive Medicine, 2025 , 52 (7) : 1278 -1283 . DOI: 10.20043/j.cnki.MPM.202407378
正文
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随着全球老龄化进程加速，老年人口的增加和更多天然牙的保留给口腔公共卫生工作带来了新的挑战[1]。口腔卫生不佳或不良口腔健康状况的长期影响使得老年人群的口腔疾病发病率明显升高，并给全身健康状况带来负面影响。2019年全球疾病负担研究显示，在全球50～74岁人群中，口腔疾病导致的伤残调整寿命年已逾800万年[2]。专业的口腔卫生服务对于维护老年人群的口腔和全身健康状况至关重要[3-4]。然而，尽管口腔卫生服务的需求随年龄的增长而增加，其利用率却随年龄增长而减少，我国老年人的口腔卫生服务利用率更是远低于国际平均水平——这提示我国老年人群存在巨大的未被满足的口腔保健需求[5-6]。因此，关注我国老年人群的牙科就医行为及其影响因素在推进全民健康覆盖和健康老龄化的进程中具有重要的现实意义。
口腔健康相关生活质量（oral health-related quality of life， OHRQoL）作为患者对身体、心理、社会功能受口腔疾病综合影响的主观评价，被认为是反映了个体口腔健康水平的重要指标之一[7]。然而牙科就医行为与OHRQoL的关联在国内外研究中存在差异。国外研究结果表明，积极的牙科就医行为作为一种有效的干预方式，能够改善老年人群的口腔健康状况以及OHRQoL[8]。针对国内人群的研究却发现牙科就医行为与更多不良口腔健康状况相关，可以被视为更差的自我感知口腔健康状况和更高的牙科治疗需求的结果[9]。
收入水平则直观地反映了老年人群的社会经济差异。一直以来，与社会经济差异相关的口腔卫生服务不平等被认为是影响牙科就医行为的重要因素，尤其是在失去主要经济收入来源的老年人群中[10]。由于牙科治疗费用和自付比例相对较高，收入较低的人群可能会因为经济压力而回避寻求口腔卫生服务，从而延误必要的牙科治疗[11]。
目前尚无研究证实我国老年人群中OHRQoL与牙科就医行为的关联，以及收入情况对两者相关性的影响。本研究以四川省65～74岁老年人为研究对象，探讨OHRQoL、收入水平以及牙科就医行为间的关联关系和影响机制，旨在进一步明确老年患者的牙科就医行为模式，以期在将来的老年口腔公共卫生工作中进行针对性地帮助与改善。
1　对象与方法
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本研究数据来自2015—2016年第四次全国口腔健康流行病学调查中四川地区的调查结果，调查方案获得中华口腔医学会伦理委员会及四川大学华西口腔医院伦理委员会批准（批准号：2014-003）。
1.1　调查对象
本研究调查对象纳入标准：年龄65～74岁；在调查抽样地区居住6个月及以上的城乡居民。排除标准：患有严重疾病或因其他原因无法、不愿完成调查。所有参与调查的受试者均已签署知情同意书并备案。
1.2　抽样方法
采用多阶段分层整群随机抽样法，选取对四川省人口具有代表性的研究对象。样本量计算公式如下：
其中，n代表样本容量，本研究抽样设计效率deff=2.5，显著性水平α取0.05，其对应置信水平μα为1.96，参考全国第三次口腔健康流行病学调查中65～74岁人群的患龋率将p值定为86%，相对允许误差δ控制在10%，无应答率（non-response rate）取15%。据此估计所需样本量为696人。
1.3　调查方法
本研究中老年人的OHRQoL评估基于老年口腔健康评价指数（geriatric oral health assessment index， GOHAI）问卷，从功能限制、疼痛不适和社会心理三个维度评价了个体对口腔健康状况的主观感受。原始GOHAI总分及各维度得分经过标准化处理后用于后续分析[12]。
通过问卷调查收集被调查者过去一年的家庭收入及家庭规模，使用收入需求比（income-to-needs ratio， INR）来表征个体的收入水平。该比率反映了被调查者家庭相对于同等规模家庭国家贫困线的年收入水平[13]。考虑到进行调查的具体时间，在本研究中收入需求比的计算方法为被调查者按家庭规模计算的人均可支配收入与2016年我国贫困标准（每人每年2 952元）的比率[14]。
此外，通过问卷调查收集了被调查者的社会人口学特征（年龄、性别、教育水平、医疗保险）、生活习惯（吸烟、饮酒情况）以及患非传染性慢性病（noncommunicable diseases， NCDs）的情况。其中，接受调查时仍在吸烟的老年人被归类为有吸烟习惯，不吸烟或已戒烟的老年人视为无吸烟习惯；饮酒频率大于或等于1次/周的老年人被认为有饮酒习惯，很少、从不饮酒或已戒酒的老年人则视为无饮酒习惯。本研究中所涉及的数据收集方法均严格按照《第四次全国口腔健康流行病学抽样调查方案》执行。
1.4　质量控制
临床检查和问卷调查均由在调查前接受过统一培训的执业口腔医师完成。在正式调查启动之前，一位标准检查者对来自四川大学华西口腔医院的三名执业牙医进行了理论与临床知识的系统培训。为确保调查质量，随机选取了5%的调查对象进行重复检查，以对比、评估三名检查员检查结果的一致性。检查者之间的一致性标准为：龋病检查结果κ>0.85，牙周检查结果κ>0.80。
1.5　统计分析
为减少数据录入过程中的错误，采用双录入的形式将数据整理到结构化的EpiData数据库中（EpiData 3.1）。后续数据分析使用SPSS 26.0完成。由于本研究中各项连续型变量不符合正态分布，用中位数（M）和四分位间距（P25，P75）描述连续变量，频数（n）、百分比（%）描述分类变量。
采用Mann-Whitney U检验和χ2检验分析OHRQoL、收入和就医行为在各控制变量上的分布差异。采用Spearman双变量相关性检验分析OHRQoL、收入和就医行为间的相关关系。在检验收入的影响作用时，首先将OHRQoL总体及各维度的标准化分数和INR做中心化处理，然后通过多层次回归分析检验收入水平的调节效应是否显著。多层次回归分析中，第一层放入性别、教育水平、医疗保险、吸烟习惯、饮酒习惯、慢性病情况作为控制变量，第二层放入OHRQoL和收入水平，第三层放入OHRQoL和收入水平的交互项。检验水准α= 0.05。
2　结果
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2.1　调查对象基本情况
最终总计纳入四川省65～74岁老年人744人，平均年龄（68.48±2.76）岁，其中552人（74.0%）报告了既往的牙科就医行为。调查对象的其他基本情况见表1。单变量分析结果显示，四川省老年人的牙科就医行为与高中及以上教育水平（P=0.005）、患其他慢性疾病（P= 0.002）、收入较高（P=0.001）、OHRQoL总体水平较差（P<0.001）以及OHRQoL功能限制（P=0.002）、疼痛不适（P<0.001）、心理不适（P<0.001）三个子维度得分较低均有相关性。
2.2　OHRQoL、 INR、就医行为描述性统计及相关性检验
表2所示为研究主要关注的各项变量的相关性检验结果。所有OHRQoL评分均已处理为均值50，标准差10的标准化分数。相关性检验结果显示，INR与OHRQoL的总体水平以及功能限制维度的评分存在正相关性，牙科就医行为发生概率与总体及各维度OHRQoL评分存在负相关性。
2.3　OHRQoL与牙科就医行为的关系：收入的调节作用
通过分层回归模型检验收入对OHRQoL与牙科就医行为间关系的调节作用，结果见表3、4。
回归模型的第一层包含所有控制变量，其中，受教育水平较高（β=0.879，P<0.01）和患其他慢性疾病（β=0.542，P<0.01）与更高的牙科就医概率有关。
第二层回归模型中放入了自变量和调节变量，结果显示，在调整控制变量后，OHRQoL总体水平（β= -0.040， P<0.001）、功能限制维度（β=-0.028， P=0.002）、疼痛不适维度（β=-0.037， P<0.001）、心理不适维度（β=-0.029， P=0.002）评分降低均与老年人牙科就医概率增加有关。同时，INR在四个模型中均表现出与就医行为的相关性——收入水平越高，牙科就医行为发生的概率越高。
第三层回归模型中放入了自变量与调节变量的乘积项，以检验INR对OHRQoL与就医行为间关系的调节作用。结果表明，INR仅对心理不适维度OHRQoL与就医行为间的关系发挥调节效应（β=-0.007， P=0.039， ΔR2=0.008）。为了更加直观地展现收入状况调节作用的大小和方向，在低收入（）和高收入（）水平上绘制了相应的交互效应图。如图1所示，与收入水平较高的老年人相比，心理不适维度OHRQoL下降对促进低收入老年人就医行为的作用更弱。
3　讨论
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本研究考察了OHRQoL与四川省老年人牙科就医行为的关系，并检验了收入水平在其中的影响。结果表明，仅有不到四分之三的四川省老年人报告了牙科就诊经历，这一比例甚至低于欧洲国家定期看牙的老年人占比[15]。OHRQoL水平是影响老年人牙科就医行为的重要因素，表现为OHRQoL总体或功能、疼痛、心理三个子维度的评分较低的老人牙科就诊的概率更高。这可能是由于，在四川省老年人群中，较差的OHRQoL表现为个体寻求口腔卫生服务的驱动因素——由于口腔保健意识不足，患者通常只有在遇到严重口腔问题时才以治疗为目的寻求口腔卫生服务。对口腔健康的重要性认识不足、对口腔疾病的负面影响缺乏了解，以及无法正确识别需要被处理的口腔健康状况等因素可能共同导致了这一现状[16-17]。
此外，研究结果表明，尽管收入较高的老年人有较高概率报告牙科就诊行为，但在多数情况下，当个体生活质量（总体水平以及功能、疼痛维度）受到口腔疾病影响而产生主观层面上的口腔保健需求时，收入并不会显著影响两者之间的关联。这一结果进一步佐证了我国老年人牙科就诊行为模式症状驱动、治疗导向的特点[18]。Lin等[19]的研究通过访谈探讨了我国老年人求医行为的基本逻辑——受到固有文化、观念的影响，老年人常常将处理日常家务的能力作为衡量健康的标准，并且倾向于将疾病发展过程中出现的不适合理化为衰老过程中的“正常现象”，避免会给日常生活秩序带来干扰的医疗程序，直到“不得不”寻求正式的医疗干预。在这样的观念引导下，即便目前的医疗保健改革通过扩大牙科医疗的保险覆盖范围等方式从宏观层面改善了卫生保健服务的可及性，老年人的医疗保健服务利用率仍然难以得到显著的提升。
需要注意的是，心理不适维度OHRQoL和就医行为的关系强度受到了收入的调节。这可能反映了一种处理口腔疾病相关问题的优先度上的排序——相比于口腔问题造成的功能限制和疼痛不适，在收入较低的情况下，老年人更倾向于忽视心理方面的护理需求[20]。这可能是由于收入较高的老年人心理健康素养较高，他们对心理健康方面的了解可能更加全面，并且更少出现与心理不适有关的病耻感[21]。然而，口腔健康相关的负面心理影响可能导致一系列严重后果——不仅增大抑郁、焦虑等心理障碍的风险，还可能通过社会参与、主观幸福感和认知功能介导牙齿缺失和日常生活功能受限间的关联[22-24]。
根据本研究所得的结果，我们提出以下几点建议：（1）关注文化教育，提升老年人健康素养。应当利用因地制宜的科普形式，帮助老年人树立正确的健康观念，了解口腔增龄性变化和口腔疾病的差异，认识口腔健康与全身健康的紧密联系，最终使其能够更加合理地评估自身的口腔保健需求。（2）将口腔保健融入适老化社会的建设当中。考虑到老年人受固有健康观念的影响较深，并且往往处于信息更加闭塞的社会环境之中，因此，除了直接面向老年人群的健康教育之外，也有必要向子女、社区工作人员以及其他医疗服务提供者等强调口腔保健的重要性，形成围绕老年口腔健康维持的高效、便捷、友善的社会支持网络。（3）重视老年人群心理健康的维护。有必要在面向老年人群的公共卫生服务中进行心理健康相关知识的宣传，引导老年人正确认识自身的心理不适情况，并在口腔健康初级卫生保健中提供必要的心理卫生支持。
综上，本研究发现，超过四分之一的四川省65～74岁老年人从未使用过口腔卫生服务，较差的OHRQoL是牙科就医行为主要驱动因素，而收入水平仅对心理不适维度OHRQoL和牙科就医行为间的关系存在调节效应。在当前人口老龄化背景下，亟需通过有效的公共卫生措施对老年人群口腔卫生服务利用率进行针对性的改善。在面向老年人的公共卫生服务中，需要将工作重点更多地放在更新老年人群的口腔健康观念上；此外，也应提高对口腔健康相关心理影响的关注。
基金
收起
  • 国家重点研发计划项目(2023YFC3605600)
  • 国家自然科学基金项目(72104162)
文献
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doi: 10.20043/j.cnki.MPM.202407378
  • 接收时间：2024-07-18
  • 首发时间：2026-03-18
  • 出版时间：2025-04-10
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  • 收稿日期：2024-07-18
基金
国家重点研发计划项目(2023YFC3605600)
国家自然科学基金项目(72104162)
作者信息
    国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔疾病防治全国重点实验室，口腔医学+前沿医学创新中心，四川大学华西口腔医院预防口腔科，四川 成都 610041

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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