人口老龄化背景下阿尔茨海默病患者卫生服务利用与经济保护模型研究

China has entered a period with peak population aging, and Alzheimer’s disease (AD) has become a serious problem of public health under the background of population aging. In this study, we want to carry out an epidemiological survey ,using a multiple-stage, stratified and random sampling method in the eastern, middle and western China. The study is to obtain the data on health service utilization of old people with AD.The present situation of the health service utilization of AD patients will be analysed, and multilevel structure equation model will be constructed according to the characteristics of the data. The relationship between health service utilization and latent variables, including access to health services, quality of health services, family care, society support, economic characteristics of family, and so on, will be analysed. The index, including catastrophic health expenses, poverty due to illness, medical insurance, inpatient reimbursement, and so on, will be used to measure the ability of financial protection of AD patients' families, and an interaction model between health service utilization and financial protection will be constructed. Based on the results of the analysis, using the expert consultation method, we will put forward the policy suggestion and explore to construct an targeted social service system for AD patients. This study will contrapuntally supply decision support for improving the competence of financial protection of AD families and the work of prevention and control of AD. Ultimately, the study will have a profound impacts on prevention and control of AD and improving the patients' health related qualty of life.

我国已进入人口老龄化高峰期，阿尔茨海默病(AD)成为我国老龄化背景下的严重公共卫生问题。本研究拟通过多阶段分层随机抽样的人群流行病学调查，在我国东部、中部和西部开展研究，获取老年人AD患者卫生服务利用相关资料，分析AD患者卫生服务利用的现状，并针对数据特征，基于多水平结构方程模型，分析卫生服务可及性、卫生服务质量、家庭照顾、社会支持、家庭经济特征等潜变量对AD患者卫生服务利用的影响。同时采用灾难性医疗支出、因病致贫、医疗保险、住院报销等指标测量AD患者家庭经济风险保护能力，构建卫生服务利用与家庭经济保护相互作用模型。根据分析结果，采用专家咨询法，提出政策建议，构建针对性的AD患者社会服务体系。本研究能为有针对性提高AD患者家庭经济保护能力，有效开展AD防控工作提供决策支持，最终将对防控AD，提高AD患者生命质量产生深远影响。

我国面临着严重的人口老龄化问题。随着人口老龄化趋势加剧，痴呆给患者、家庭及社会带来沉重的负担。阿尔茨海默病是老年痴呆的主要亚型。本研究进行了多阶段分层随机抽样的流行病学调查，通过简易智能状态检查量表（MMSE）调查，结合画钟试验在上海地区筛查痴呆者，获得基于社区的老年痴呆患病情况，同时采用一般情况调查问卷调查其人口学特征、家庭经济状况、合并慢性病情况、卫生服务利用、社会支持等情况，采用健康相关生命质量量表（SF-12）调查研究对象的生命质量，采用焦虑和抑郁自评量表调查焦虑和抑郁症患病情况。对比分析痴呆组和非痴呆组上述因素的差别，探讨相关影响因素，并采用灾难性医疗支出评价家庭经济保护能力。利用倾向性评分方法消除比较组间混杂因素不均衡问题，分析灾难性医疗支出与老年痴呆、卫生服务利用等的相互关系。.共收集了有效问卷4715份。结果显示社区老年痴呆患病率为8.80%，女性、住在郊区、年龄大、文化程度低、抑郁、合并其他慢性病者患痴呆的风险高，而饮酒、适度锻炼、高家庭收入可降低患痴呆的风险。SF-12量表8个维度得分均显示痴呆组低于非痴呆组，说明痴呆组健康相关生命质量低。痴呆组调查对象年住院率高于非痴呆组。痴呆组发生灾难性医疗支出的风险高于非痴呆组，且两周患病率高和一年内住院率高等因素亦增加发生灾难性医疗支出的风险。这些情况均说明痴呆给患者及其家庭带了沉重的经济负担。.本研究结果为有效开展社区老年痴呆流行病学研究提供基础数据和方法，为开展痴呆防控工作，降低痴呆者家庭经济风险、提高经济风险保护能力提供了数据支持，也为其他学者进行老年痴呆相关研究提供重要参考。.