高等教育对婚育行为影响的历时演变——兼论原生家庭社会阶层的异质性影响

人口负增长形势下,考察育龄人群婚育行为的影响机制及其潜在变化,对于全面理解当前年轻人的晚婚和低生育行为、制定有效的家庭支持措施具有重要意义。文章利用2006～2021年中国综合社会调查数据,分析了高等教育对初婚和生育行为的影响及其随时间变化趋势,重点检验了高等教育扩招以来原生家庭社会阶层的异质性影响。研究发现,接受高等教育会显著推迟个人的初婚年龄,减少其生育数量;随着时间的推移,高等教育对个人初婚年龄的推迟效应在年轻队列中明显增强,但对生育数量的抑制效应有所减弱。在原生家庭社会阶层较低的群体中,高等教育对生育行为的抑制效应更为显著;不过,相应异质性并未随时间扩大。在年轻的出生队列中,较高社会阶层出身的高等教育学历者实际生育的数量显著更低,反映了家庭成长环境及价值观念对高学历年轻人生育行为的重要影响。基于此,文章强调生育支持政策体系的建构应当重视不同群体生育状况的异质性,有针对性地设计政策干预,为育龄人群的家庭构建行为提供更有效的支持。     

新城区老年人慢性病伤对日常生活功能的影响研究

本文初步分析了老年人患有慢性病伤对日常生活功能的影响，主要研究结果如下：（１）随着慢性病伤数目的增加，老年人的自理能力、操持家务能力和躯体活动能力的丧失均呈快速上升趋势；（２）引起老年人群功能障碍的慢性病伤主要为循环系统和运动系统病伤；（３）与自理和操持家务能力相比，躯体活动能力较容易受到慢性病伤的影响，在理论上，这一结果在一定程度上反映了自理和操持家务能力是人和他所处的生活环境共同作用的结果，在实践上，提示改善生活环境在维持老年人独立生活能力中的重要性。     

人口流动与艾滋病传播

从生物医学的流行病学理论来看,人口流动对传染病传播在理论上具有推波助澜的作用,尤其是对于通过感染者和易感人群接触就能传播的传染病,流动的易感者有更大机会接触到传染源;同理,流动的传染源也更有机会接触到易感人群。这一理论在各种传染病案例中都得到了验证。在艾滋病研究领域,最流行的观点也秉承了传染病学中的经典理论——认为人口流动是艾滋病蔓延的重要＂推手＂之一。     

中国高龄老人就医及时性状况研究

基于 1 998年中国高龄老人健康长寿调查数据 ,对中国高龄老人患病能否得到及时医治的状况进行了分析。结果表明 ,高龄老人调查当时若患病 ,只有 3 7%左右的高龄老人不能得到及时医治 ;农村 (4 2 % )该比例略高于城镇 (3 0 % ) ;患病得不到及时就医的群体比较固定。LOGISTIC回归还揭示患病由家庭成员提供照料服务的高龄老人比由社会提供照料服务的高龄老人得不到及时医治的可能性小 ,与患病不能及时医治的高龄老人相比 ,患病能得到及时医治的高龄老人健康自评好的比例高 ,完全自理的比例高 ,认知健全比例高 ,疾病对日常生活妨碍比例小 ,隶属健康纯类的可能性大 ,其后死亡的可能性小 ,健康存活的可能性大。说明患病得到及时治疗对高龄老人晚年健康促进和生存具有一定的影响。     

吉林省老年人群治疗费用分析——基于卫生费用核算体系“SHA 2011”

随着医疗技术的快速发展,人口老龄化日趋严重,医疗卫生支出显著提高,疾病经济负担增长,这无疑给医疗卫生体制改革与社会和谐稳定发展带来了巨大经济压力。在老龄化日益加剧的情况下,探讨老年人医疗保障制度的安全性和可持续性需要深入研究老年人医疗费用支出的变化特点和趋势。本文采用国际通行的"卫生费用核算体系2011"(SHA 2011)对2014年吉林省65岁以上老年人群治疗费用进行分析。结果显示治疗费用源于公共筹资占55.58%,其次为家庭卫生支出41.83%;治疗费用居于前五位的疾病类型依次为:循环系统疾病、呼吸系统疾病、消化系统疾病、肿瘤、内分泌、营养与代谢疾病;省级医疗卫生服务机构的费用以门诊服务为主(84.63%),基层医疗卫生服务机构的费用中住院服务占比最高。研究结论指出,不同年龄组老年人群治疗费用的疾病分布存在集中性,老年群体缺乏有针对性的医疗保障项目,家庭自付比例较高,卫生资源机构配置有待完善。应积极发挥不同级别医疗卫生服务机构服务职能,合理控制老年人群治疗费用,逐步完善老年人医疗保障体系,推进医养结合融合发展。     

城市劳动适龄人口死亡态度的影响因素分析

死亡态度直接影响个体的生命和生活质量。利用在成都市城市社区进行的抽样调查数据,对影响城市劳动适龄人口死亡态度的个人和家庭因素进行分析。结果发现,文化程度、婚姻状况、身体健康状况和家庭谈论死亡情况是影响城市劳动适龄人口死亡态度的因素。高文化程度和忌讳谈论死亡的家庭环境对城市劳动适龄人口的死亡态度有负向影响,在婚增加城市劳动适龄人口对死亡排斥的倾向性,患有慢性病或自评精神健康好的城市劳动适龄人口更倾向于接受死亡。研究结果可为城市劳动适龄人口的死亡教育的实施、保障和促进该群体的生命、生活质量的提高提供有益的参考。     

空气污染、社会经济地位与居民健康不平等——基于CGSS的微观证据

本文利用中国综合社会调查(CGSS)数据,基于Grossman健康生产函数详细考察空气污染、社会经济地位对居民健康的影响机制及城乡异质性,进一步识别空气污染与社会经济地位协同作用对居民健康不平等的分化机制。研究结果显示在中国18岁及以上的成年人口中,社会经济地位较高的人群拥有更好的自评健康水平,这种群体健康分化主要来自社会经济地位正效应和空气污染负效应的综合影响。城乡居民之间的健康差异主要来自收入的绝对差异和偏效应差异以及社会阶层和教育水平的城乡差异。空气污染对居民健康不平等具有显著的分化机制,其作用途径是通过调整社会经济地位尤其是收入效应来实现的,这种分化机制在城市居民中表现得尤为突出。因此,相关政策的设计实施应该更加关注环境健康风险以及健康不平等的加剧:一是要加强环境规制,严控大气污染,降低居民整体暴露风险;二是要推进基本公共服务均等化,提高弱势群体应对健康风险的能力;三是要加强城乡教育培训的扶持力度,缓解收入差距和教育分化引致的健康不平等。     

人口平均预期寿命及疾病影响因素分析

本文使用生命表的研究方法对2016年吉林省死因监测数据进行分析,推算吉林省人口平均预期寿命,分析主要疾病对预期寿命的影响。研究结果表明2016年吉林省总人口平均预期寿命是78.12岁,其中男性为75.83岁,女性为80.61岁。与2010年第六次人口普查吉林省人口平均预期寿命相比总人口平均预期寿命提高了1.94岁,其中男性提高了1.71岁,女性提高了2.17岁。分析疾病因素对人口死亡的影响,主要疾病致死率非常高,其中前10位死亡原因引起的死亡比例占98.94%,前4位死亡原因引起的死亡人数占总死亡人数的90.9%,影响较大的疾病包括循环系统疾病、肿瘤、呼吸系统疾病、消化系统疾病、内分泌系统疾病等。进一步分析主要疾病对人口平均预期寿命的影响发现,循环系统疾病是对人均预期寿命影响最大的疾病,因循环系统疾病死亡的人数占总死亡人数的一半以上。要想降低疾病的发生率及致死率,进而提高人均预期寿命,必须依靠全社会的共同努力。针对疾病发生的危险因素,建立危险因素的识别与干预体系,倡导健康生活方式,建设公共安全环境。     

我国人口流动中的健康选择机制研究

利用2008年中国流动与健康调查数据,对农村留守人口、农村外出返乡人口、乡城流动人口以及城镇居民等不同流动特征群体之间的健康差异进行比较,并系统检验了我国人口流动过程中的两种健康选择机制——"健康移民"(healthy migrant)效应和"三文鱼偏误"(salmon bias)效应。模型分析结果表明,我国人口流动存在着较为明显的"健康移民"和"三文鱼偏误"选择效应。在控制被访者的年龄、性别、主要社会经济特征以及相关健康行为后,流动人口自评一般健康、慢性病状况、经常性身体不适和肺活量等健康指标显著优于农村留守人口,乡城流动人口患有慢性病和出现经常性身体不适的可能性也显著低于农村返乡人口。在控制相关变量后,乡城流动人口与城镇居民的健康状况(除慢性病和心率过高症状外)不存在显著差别。     

疾病和失能对老年人口健康预期寿命的影响--兼论卫生资源在老年人口健康分类投资的方向

本文根据1998年第二次国家卫生服务调查分析数据和常规卫生统计资料,采用Sullivan方法分析了三种在人群中仍有较高发病率的病毒性肝炎、疟疾、结核等传染性疾病及慢性病和失能对中国围老龄期和老龄期人口健康预期寿命的影响,目的是了解不同的非健康状态对老年人口健康水平影响的程度,为中国有限的卫生资源流向提供一些参考信息.     

The World Health Organization and the Globalization of Chronic Noncommunicable Disease

Chronic noncommunicable diseases (NCDs) in low‐ and middle‐income countries have recently provoked a surge of public interest. This article examines the policy literature—notably the archives and publications of the World Health Organization (WHO), which has dominated this field—to analyze the emergence and consolidation of this new agenda. Starting with programs to control cardiovascular disease in the 1970s, experts from Eastern and Western Europe had by the late 1980s consolidated a program for the prevention of NCD risk factors at the WHO. NCDs remained a relatively minor concern until the collaboration of World Bank health economists with WHO epidemiologists led to the Global Burden of Disease study that provided an “evidentiary breakthrough” for NCD activism by quantifying the extent of the problem. Soon after, WHO itself, facing severe criticism, underwent major reform. NCD advocacy contributed to revitalizing WHO's normative and coordinative functions. By leading a growing advocacy coalition, within which The Lancet played a key role, WHO established itself as a leading institution in this domain. However, ever‐widening concern with NCDs has not yet led to major reallocation of funding in favor of NCD programs in the developing world.     

Determinants of Mortality at Older Ages: The Role of Biological Markers of Chronic Disease

Researchers have had a longstanding interest in understanding the determinants of mortality. This article examines the impact of a broad array of biological markers, together with self‐reports of physical and mental health status, on the probability of dying for older adults. The estimates are derived from logistic regression models based on data from a national survey in Taiwan. The analysis confirms previous studies demonstrating the effects of clinical measures related to metabolic syndrome on mortality and identifies detrimental effects of neuroendocrine and immune‐system markers. The results reveal that biomarkers provide independent explanatory power in the presence of self‐reported health measures. The associations between biomarkers and mortality found here provide new avenues for projecting future mortality and elucidating differences in longevity across populations.     

Chronic Pain and Older Women:

Drawing upon the available research literature, this article highlights the research and practice issues that must be addressed if we are to be responsive to the chronic health problems, and subsequent pain, that often codront individuals as they age. This list should by no means be 'seen as exhaustive, but rather as a starting point from which to further our understanding of chronic pain in the lives of older women.     

Heart Disease and Older Women

Heart disease has traditionally been thought of as a man's disease. However, one in three older women develop heart disease, making it the leading cause of death in older women. Current treatment for heart disease is based largely on studies using males as subjects. Doctors are just now beginning to learn about differences in men and women who have heart disease. The focus of this discussion is heart disease as it relates specifically to women. Risk factors considered are smoking, high blood pressure, elevated blood lipids, diabetes mellitus, obesity, stress, family history and physical inactivity. Diagnosis, treatment options and strategies for living productively with heart disease are presented.     

Alzheimer's Disease and Older Women

The graying of America suggests that dementia will become "the epidemic of the 21st century." First described in 1907, Alzheimer's Disease (AD) accounts for an estimated two-thirds of all dementia. AD currently has no cure, thus causing a major drain on health care and family resources. Compared to men, women are uniquely affected by AD due to their gender-associated increased risk, longer life span, and roles as caregivers within families and institutions. Living successfully with dementia requires medical and behavioral interventions to manage disruptive symptoms, knowledge to optimize environmental conditions, and caregiver support and savvy to avoid burnout. Strategies for maximizing functioning in older women living with AD are provided.     

The DYNAMO-HIA Model: An Efficient Implementation of a Risk Factor/Chronic Disease Markov Model for Use in Health Impact Assessment (HIA)

In Health Impact Assessment (HIA), or priority-setting for health policy, effects of risk factors (exposures) on health need to be modeled, such as with a Markov model, in which exposure influences mortality and disease incidence rates. Because many risk factors are related to a variety of chronic diseases, these Markov models potentially contain a large number of states (risk factor and disease combinations), providing a challenge both technically (keeping down execution time and memory use) and practically (estimating the model parameters and retaining transparency). To meet this challenge, we propose an approach that combines micro-simulation of the exposure information with macro-simulation of the diseases and survival. This approach allows users to simulate exposure in detail while avoiding the need for large simulated populations because of the relative rareness of chronic disease events. Further efficiency is gained by splitting the disease state space into smaller spaces, each of which contains a cluster of diseases that is independent of the other clusters. The challenge of feasible input data requirements is met by including parameter calculation routines, which use marginal population data to estimate the transitions between states. As an illustration, we present the recently developed model DYNAMO-HIA (DYNAMIC MODEL for Health Impact Assessment) that implements this approach.     

Chronic Musculoskeletal Pain:

Two diseases, osteoporosis and osteoarthritis, are responsible for a majority of the chronic musculoskeletal pain that older women experience. Osteoporosis is the metabolic bone disease most common in older women and is responsible for fractures, kyphosis, and chronic pain. Osteoarthritis, the most commonly diagnosed musculoskeletal problem in older women, causes degeneration of the weight-bearing joints in the body, resulting in limited function and chronic pain. In this paper, these and other common disorders are briefly described and typical coping strategies used by older women in pain are reviewed. In addition, potential multidisciplinary treatment regimens are discussed.     

Chronic conditions and the decline in late-life disability

Using data from the 1997-2004 National Health Interview Survey (NHIS), we examine the role of chronic conditions in recent declines in late-life disability prevalence. Building upon prior studies, we decompose disability declines into changes in the prevalence of chronic conditions and in the risk of disability given a condition. In doing so, we extend Kitigawa's (1955) classical decomposition technique to take advantage of the annual data points in the NHIS. Then we use respondents' reports of conditions causing their disability to repartition these traditional decomposition components. We find a general pattern of increasing prevalence of chronic conditions accompanied by declines in the percentage reporting disability among those with a given condition. We also find declines in heart and circulatory conditions, vision impairments, and possibly arthritis and increases in obesity as reported causes of disability. Based on decomposition analyses, we conclude that heart and circulatory conditions as well as vision limitations played a major role in recent declines in late-life disability prevalence and that arthritis may also be a contributing factor. We discuss these findings in light of improvements in treatments and changes in the environments of older adults.     

高龄老人的健康、疾病与死亡

在未来几十年,中国老年人口占总人口的比例会不断增加,高龄老人数量也会不断扩大,因而关注高龄老人疾病与健康,探讨健康长寿的机理很有必要.     

Assessment of Older Women with Chronic Pain

Females suffer from a larger number of chronic pain syndromes, live longer with chronic pain and disability, and more often live alone than males. Thus, they should be prime candidates for pain treatment. Yet a number of factors inhibit geriatric patients from receiving rehabilitation for their pain. Chronic pain has been determined to be a complex perceptual event that is influenced by psychosocial, behavioral, and biomedical factors. A comprehensive strategy for assessing chronic pain patients is described. Special attention is given to the association between pain and depression and the important medication of perceived interference with life, social support, and functional activities as these variables appear to be particularly relevant to a geriatric pain population.