基于Diderichsen理论的慢性病健康差异测量及其影响因素模型构建

NCDs contribute to health inequalities in China, the socioeconomically and otherwise disadvantaged populations in China are often hit harder by NCDs than the affluent members of society, (a) the risk factors of NCDs and NCDs tend to be more prevalent among the poor; and (b) the poor are often lacking in or have limited access to quality health care when they develop an NCD; and (c) the adverse impact of chronic diseases on income and overall family welfare is proportionally larger for the poor as well. These health inequalities exist at various development stages of NCDs (including exposure of risk factors, occurrence, response and outcomes). The mechanism of health disparities of Diderichsen theory are that populations with different soccieconomic status have different exposures of health-related factors, and the same exposures produce different health effects at different populations, and different populations have the different consequences as result of the diseases. Such health inequities of NCDs are unfair and unreasonable, so it is imperative to measure health inequalities of NCDs, to analyze the mechanisms and pathways of impact factors, and to provide specific strategies for reducing health inequities. The study goal is to measure health inequalities of NCDs，to clarify how social determinants lead to health disparities throughout the various stages of development of NCDs, to analyze the mechanisms of impact factors (identify disadvantaged people and entry points for policy action), and to provide specific strategies to reduce health inequities of NCDs.

在我国，慢性病健康不公平已经成为严重的公共卫生及社会问题。在慢性病各个发展阶段中，包括从危险因素暴露到患病，再到患病后疾病应对及疾病结局，均存在相应健康不公平。Diderichsen理论认为健康差异产生机制为不同社会经济阶层中健康相关因素的暴露不同，同样的暴露在不同社会经济阶层中产生的健康影响不同，不同社会经济阶层中患病后果不同。因社会经济状况差异而导致这样的健康差异是不公平、不合理的。为此，本研究拟在Diderichsen理论指导下，利用纵向追踪数据全面的测量慢性病各个发展阶段的健康差异程度，评估各维度社会经济状况对慢性病健康差异的贡献额度，运用PLS路径模型分析社会经济状况如何自始至终地影响着慢性病各个发展阶段中健康差异的产生，进而识别慢性病疾病负担最沉重亚群（弱势人群）；同时构建慢性病健康差异影响因素作用机制模型，并界定弥合健康差距的政策切入点；最后构建弥合慢性病健康差距的系统策略。

项目背景. 在老年慢性病各个发展阶段中，从危险因素暴露到患病，再到患病后疾病所造成的不良结局，均存在不同社会经济状况老年人群之间的健康差异问题。目前，越来越多的国家把影响健康差异的社会决定因素作为重要的政策关注点。加强对健康差异的测量（如老年慢性病方面），挖掘导致健康差异的原因，并针对这些原因设计相关政策是弥合健康差距的重要途径。. 主要研究内容. 本研究基于 Diderichsen模型来构建老年慢性病健康差异影响因素作用机制理论框架，测量老年慢性病各个发展阶段的健康差异及其纵向趋势，识别老年慢性病疾病负担最沉重的亚群(脆弱人群)；并采用Partial Least Squares (PLS)路径模型分析导致老年慢性病各个发展阶段健康差异的影响因素及作用路径，界定阻断作用路径的政策切入点；最后构建弥合老年慢性病健康差距的政策策略。. 重要结果及关键数据. 不同SES老年人群慢性病危险因素风险暴露可能性、慢性病自报被诊断患病风险可能性、慢性病疾病健康结局存在差异；SES较差老年人群在慢性病危险因素暴露方面为弱势群体，SES较差老年人群在慢性病疾病健康结局方面为弱势群体。SES由始至终地影响着老年慢性病各个发展进程中健康差异。老年SES对老年慢性病危险因素暴露风险的负向直接影响，对老年慢性病自报患病风险的正向直接影响，对老年慢性病疾病健康结局的正向直接影响；而且老年SES通过慢性病危险因素暴露间接负向影响老年慢性病自报患病，老年SES也通过慢性病危险因素暴露和老年慢性病自报患病间接负向影响老年慢性病疾病健康结局。. 科学意义. 本研究以 Diderichsen模型为基础，构建老年慢性病健康差异影响因素作用机制的理论框架，为老年慢性病的健康差异研究提供了新的思路和视野。通过系统的测量老年慢性病各个发展过程中健康差异现状来识别老年慢性病疾病负担最沉重的亚群，挖掘导致老年慢性病健康差异的影响因素作用路径来界定弥合慢性病健康差距的政策切入点，有助于探讨弥合老年慢性病健康差距的实现策略与政策选择可以为慢性病源头防控策略提供依据。