基于“健康中国2020”目标的二维人口健康不公平指数研究

目的：本研究基于“健康中国2020战略”，旨在开发一种可综合评价人口健康公平性的二维指数。这里将公平性定位于“人口健康产出的平等”。方法：应用生态学研究、因子分析等方法对中国31个省、自治区和直辖市的人口健康不公平指数进行测算。之后。对健康不公平指数的信度和效度进行检验。资料主要来源于2003年国家卫生服务调查数据。结果：由8个变量合成的中国人口健康不公平指数（IHI）的中住数为0．27838π（范围：0π～0．39002π）。该指数具有较高的内部一致性（Cronbach α系数＝0．8304）和信度（Spearman相关系数〉0．8．P〈0．05）。IHI与社会剥夺指数（Spearman相关系数＝0．731，P〈0．05）、期望寿命（Spearman相关系数＝-0．569，P〈0．05）和基尼系数（Spearman相关系数=0．805。P〈0．05）间具有较好的相关性。结论：IHI是一种二维、具有较好信度和效度的监测“健康中国2020”战略的指数．它与基尼系数相比在对人口健康公平性的综合评估方面更具优势。该指数还可应用于政策干预效果评价、弱势群体的确定及卫生资源分配等领域。

A Bidimensional Inequity-in-Health Index Based on the Health China 2020 Strategy

Objectives： This paper aims to develop a Inequity-in-Health Index （IHI） assuming inequity as ＂inequality of health outcomes＂ based on the Health China 2020 Strategy in China. Methods： Ecological study. 31 provinces and municipalities in China were included from 2003 National Healthcare Survey dataset. The reliability and validity of this bidimensional IHI were tested. Meanwhile, factor analysis was used in this study. Results： The IHI, which was constructed with eight variables, had high internal consistency （Cronbach＇s alpha=0.8304）, was reliable （Spearman〉0.8, P〈0.05）, and had 0.27838π around China （range： 0π-0.39002π）. IHI had high correlation with the Social deprivation index （Spearman=0.731, P〈0.05）, Life expectancy （Spearman=-0.569, P〈0.05）, and Gini coefficients （Spearman=0.805, P〈0.05）. IHI had sensitivity to change. Conclusion： IHI is a bidimensional, valid and reliable index to monitor the Health China 2020 Strategy in China. Comparing with Gini coefficient, IHI gives a better estimation of the composite inequity in health. IHI could also be used in the areas of testing the potential impact of further interventions on equity in health, of identifying the vulnerable population and of allocating the health resource ctc.