基于家庭社会经济地位的儿童生存水平研究

儿童的生存、保护和发展是当今国际社会优先考虑的问题之一，提高儿童健康水平，关键在于改善儿童健康的公平性。基于浙江省30个监测县（市、区）2012—2014年5岁以下死亡儿童家长或监护人的回顾性问卷调查，研究结果显示，家庭社会经济地位分层越高，儿童死亡地点为医院的概率越高，上层家庭为下层家庭的2.193倍；儿童死亡前接受住院治疗的比例也越高，上层家庭为下层家庭的2.904倍；儿童死因诊断级别也越高，上层家庭儿童死因诊断级别为省市级医院的比例是下层家庭的3.233倍。儿童生存水平与家庭社会经济地位密切相关，社会经济地位越高，其儿童的卫生医疗服务利用率就越高。

A Study on the Survival Rate in Children Based on Family Socio-economic Status

Today the survival, protection and development of children is a prioritized global issue, of which the survival rate is of primary significance. The key to improve the health condition in children lies in the promotion of equity. China is in a period of social transition, and its inequality is highly prominent in all aspects of the society, especially in the field of public health. The socio-economic status reflects inequality between different social groups, and has become a heated topic in the research of public health. Most studies have been focusing on adults as the object. However, the survival rate of children is the most significant contributing factor to the average life expectancy of the population. This study applies questionnaire surveys to collect data from a large numbers of samples, and explains the impact of socio-economic status on the survival rate in children from an empirical standpoint. Furthermore, it puts forward some suggestions in policy-making to improve the survival rate in children. This study has compensated for the lack of research data in this area in China and abroad, and provides a new perspective in the research of children’s health. Samples include the cases of death in children in 30 counties (cities, districts) in Zhejiang Province during the year 2012 to 2014. Self-designed questionnaire of ″Surveys on death cases in children under the age of 5″ was handed out to first-line workers in monitoring. Once a case of childhood death under the age of 5 occurred, the parents or guardians were called immediately to fill in the retrospective questionnaire. The logistic regression model was used to analyze the impact of socio-economic status on the mortality of children, parameters include the venue of death, treatment received before death, and the stratification of diagnosis made. A total of 3 498 valid questionnaires were recalled, with an effective rate of 99.15%. From the venue of death, 52.2% died in the hospital, 14.2% died during transportation to the hospital, and 33.6% died at home. From the treatment received, 55.2% were hospitalized, 27.2% were outpatients, and 17.6% received no treatment. In the stratification of diagnosis of death, 45.2% cases were diagnosed in provincial and municipal hospitals, 44.8% were diagnosed in the county hospitals, 4.9% were diagnosed in clinics from lower levels, and 5.1% did not visit any hospitals or clinics. Based on the socio-economic status stratification standards, the upper level accounted for 9.4% of the death cases, the upper middle level accounted for 16.4%, the middle level accounted for 41.3%, the lower middle level accounted for 23%, and the lower level accounted for 9.9%. Logistic regression model showed that with higher socio-economic status of the family, there was a higher probability for the children’s death to take place in the hospital, with the difference of 2.193 times in the upper-level families compared with the lower-level. There was also positive association between the socio-economic status of the family and the rate to be admitted to the hospital before death, with the difference of 2.904 times in the upper-level compared with the lower-level families. This is also the case in the stratification of the hospital level, the number of cases diagnosed in provincial and municipal hospitals from the upper-level was 3.233 times higher than the lower-level families. Familial socio-economic status affects children’s survival rate through influencing prenatal health care, health environment and social resources of their families. Meanwhile, the level of child survival is also affected by whether the children were from urban or rural area and their household registration. Policymakers should focus on children with low socio-economic status by increasing health investment, establishing advanced social support systems and promoting the policies that would benefit for these children. Furthermore, investment on maternal and child healthcare should be increased and the maternal and child health resources need to be allocated in a scientific way to improve the health level of children.