广西少数民族农村老年人身心健康与社区环境因素关系研究

Health ageing in minority rural communities contributes to China's national harmonony and security. There is lack of information for health issues of the elderly people inhabited in the minority rural areas, mandate a well-designed large-scale survey on the issue. In this proposal, we focus on Guanxi's eleven ethnicities such as Zhang, Miao, Hui, Yao, Dong, Yaolao, Maonan, Jing, Yi, Shui, and Yillao minority. The total population is approximately eighteen million and most of them live in remote, poor, rural mountainous areas. Outcome variables in this study are health-related quality of life and mental health. The determinants include the after-mentioned explanatory variables of interest and other confounding variables..Our objectives are as follows: (1) To understand the distribution and level of two outcome variables among the elderly in Guanxi eleven minority rural regions; (2) To explore correlation between the outcome variables and ethnical culture variables such as their traditional custom, religious belief, and festival; (3) To examine the association of two outcome variables with their income, geographical location, medical facility and geographical access to health care in native villages; (4) To examine whether health human resources and the facilities for the elderly at township is related to two outcome variables; and (5) To investigate possible mechanism linking the rural neighborhood factors to the elderly health..This cross-sectional household survey is based on community levels such as native village and township in 11 minority counties and one Han ethnicity county, targeting 36 townships, 216 natural villages, and 12912 elderly people. Both qualitative and quantitative research will be used. Information will be collected by interviewing individuals, household host and cadres working in villages and towns, using constructed questionnaires and semi-constructed interview guidelines. Multilevel modeling analysis will also be utilized..Our research will provide evidence for policy-makers to optimize allocation of human health resources, improve traffic situation and medical facilities for the elderly in remote rural areas. The findings from the project will add new knowledge of health-related life quality and psychological health theory of the elderly from different ethnicitites, which is essentiall to preserve culture heritage and modify unfavorable custom.

少数民族农村老年人健康问题不仅是重要的公共卫生问题，而且事关民族和谐与团结。民族文化、社区环境与健康的关系是欧美社会流行病学的研究热点。然而，国内有关少数民族文化和农村社区环境因素对老年人健康影响的研究甚少。本项目拟对广西11个典型少数民族农村老年人身心健康进行横断面入户调查，采用深入访谈和多水平模型等定性定量研究方法，了解少数民族农村老年人生命质量和心理健康状况及分布规律，探索少数民族文化（如风俗习惯、宗教信仰和节假日）和农村社区环境（如自然村经济状况、地理位置、医疗卫生服务地理可及性，及乡镇医疗卫生人力资源、养老设施）等因素与老年人生命质量和心理健康的关系，阐明它们之间的机制，为制定优化农村基层医疗卫生资源配置、改善交通状况和养老设施等促进少数民族农村老年人身心健康的公共政策提供理论依据；对提高少数民族农村老年人健康意识、改变不良风俗习惯、丰富和完善民族生命质量和心理学理论有指导意义。

少数民族农村老年人身心健康状况是重要公共卫生问题。然而，有关研究甚少。本项目对广西9个少数民族农村老年人身心健康进行横断面入户调查，采用定性定量研究方法，了解他们的身心健康状况及分布规律，检查少数民族文化和农村社区环境因素与老年人身心健康的关系；主要结果为：.① 疼痛/不适是最常见健康问题，其次是焦虑/抑郁。不同少数民族老年人生命质量存在差异，但未见居住地隔离对生命质量的影响。壮族和京族老年人EQ-5D健康指数最高，回族和苗族老年人最低。年龄大、收入差、文化程度低、女性、有慢性病以及有过住院史的老年人生命质量低于其它人群。.② 男性老年人的期望寿命和生命质量调整期望寿命分别为20.9和18.0年，女性分别为24.2和20.3年。男性和女性老年人的平均损失生命质量调整期望寿命分别为2.9和3.8年。男性和女性老年人的期望寿命与损失生命质量调整期望寿命的相关系数分为别-0.53和0.12。考虑生命质量影响后，不同少数民族老年人的生存状况（含生存时间和生存质量）仍然存在差异。.③ 不同民族老年人SCL-90总分及因子得分有差异，回族总分最高，壮族最低。侗族老年人恐怖因子得分最高，回族老年人在强迫、人际关系敏感、偏执、精神病性等四个因子得分均为最高或较高，京族老年人在躯体化、抑郁、偏执和其他（反映饮食、睡眠等情况）等四个因子得分为最高或较高，瑶族老年人在其他因子得分最高，汉族老年人在焦虑和敌对两因子得分最高，壮族老年人在所有因子得分均为最低。. ④ 少数民族地区农村老年人文化参与率较低，其中自然村文化活动场所缺乏是主要影响因素。. ⑤ 不同少数民族农村老年人的社会支持存在不同，且表现为不同民族具有不同社会支持维度的特征。. 这些研究结果可为制定优化农村医疗卫生资源配置、改善经济状况和建立文化娱乐场所等促进健康的公共政策提供依据；对提高少数民族居民健康意识，改变不良风俗习惯有指导作用；对丰富民族生命质量和心理学理论有重要价值。