The mediating effect of income level between health literacy and self-assessed health
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摘要:
目的 分析农民收入水平在健康素养与自评健康（self-assessed health，SAH）间的中介效应，为农村地区开展健康促进提供依据。 方法 采用多阶段抽样方法，对甘肃省16 349名18~69岁农民进行问卷调查。 结果 甘肃农民健康素养水平为9.7%；健康素养平均得分（33.40±14.33）分；多元线性回归显示民族、文化程度、收入水平是影响农民健康素养的主要因素。健康素养得分汉族高于其他民族，且呈现随文化程度与经济收入升高而上升、随年龄增高而下降的趋势（均有P < 0.001）；健康素养与SAH间呈线性相关关系（P < 0.05）；健康素养对SAH的总效应为0.028 3，通过收入水平的中介效应为0.003 9，相对中介效应13.78%。 结论 健康素养可通过收入水平影响健康状态。 Abstract:Objective To analyze the mediating effect of income level between health literacy and self-assessed health among peasants, so as to provide scientific basis for health education and health promotion. Methods Using stratified multistage random sampling, we conducted a questionnaire survey among 16 349 peasants. Results The health literacy level was 9. 7% among peasants in Gansu. Multiple regression analysis showed that nationality, education level and per capita income were main factors affecting farmers' health literacy. The higher the education and income level, the higher the level of health literacy (all P < 0.05). It showed a linear correlation between health literacy and self-assessed health. The total effect of health literacy on self-assessed health was 0.028 3; The mediating effect of literacy through income was 0.003 9, and the relative mediating effect was 13.78%. Conclusions The level of health literacy of peasants in Gansu is at a low level; Health literacy can affect health status through income level. -
Key words:
- Peasants /
- Health literacy /
- Influencing factors /
- Self-assessed health /
- Mediating effect
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表 1 调查对象的基本信息
Table 1. Characteristics of eligible individuals
人口学特征 样本数(n) 构成比(%) 健康素养得分(x±s) t/Z值 P值 性别 5.92 ﹤0.001 男 8 222 50.3 34.06±14.38 女 8 127 49.7 32.73±14.25 民族 13.16e ﹤0.001 汉族 14 512 88.7 33.93±14.31 其它 1 837 11.3 29.21±13.75 年龄(岁) 138.16f ﹤0.001 18~ 592 3.9 34.45±14.74 25~ 1 893 11.5 35.56±14.96 35~ 2 860 17.4 34.46±14.37 45~ 6 142 37.5 33.37±14.02bc 55~ 3 485 21.3 32.38±14.23abc ≥65 1 377 8.4 30.51±14.05abcd 受教育程度 1183.99f ﹤0.001 不识字或识字很少 4 646 28.4 28.72±13.49 小学 5 642 34.5 32.37±13.89a 初中 4 871 29.9 37.20±13.88ab 高中/职高/中专 1 069 6.6 40.92±13.94ab 大专/本科/硕士 121 0.7 41.77±15.60ab 婚姻状况 29.68f ﹤0.001 未婚 931 6.0 33.65±15.07 已婚 14 340 87.4 33.55±14.26 分居 54 0.3 31.74±15.05 离异 237 1.4 32.68±13.74 丧偶 787 4.8 30.78±14.46ab 是否患慢病 5.14 ﹤0.001 否 12 271 75.1 33.73±14.34 是 4 078 24.9 32.40±14.25 家庭人口数 2.54e 0.011 ≤4 9 899 60.5 33.53±14.43 ≥5 6 450 39.5 33.19±14.17 家庭年收入(元) 117.77f ﹤0.001 0~ 3 120 19.1 31.68±14.37 10 000~ 4 350 26.6 32.89±14.53a 20 000~ 4 252 26.0 33.35±14.46a ≥30 000 4 627 28.3 35.08±13.80ab 合计 16 349 100.0 33.40±14.33 注：a表示与第1组比较；b表示与第2组比较；c表示与第3组比较；d表示与第4组比较，e表示独立样本t检验；f表示多样本Kruskal-Wallis H检验 
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表 2 甘肃省农民健康素养影响因素多元回归分析
Table 2. Multiple regression analysis on influencing factors of health literacy among farmers in Gansu Province
影响因素 标准误 标准系数 t值 OR(95% CI)值 P值 常数 0.853 35.304 30.247(28.567~31.926) ＜0.001 民族 1.000 汉族 其他 0.351 -0.057 -7.345 -2.581(-0.327~-1.893) ＜0.001 文化程度 不识字/识字很少 1.000 小学 0.280 0.112 12.063 3.381(2.832~3.931) ＜0.001 初中 0.303 0.254 26.272 7.953(7.360~8.546) ＜0.001 高中/职高/中专 0.483 0.202 24.226 11.698(10.751~12.644) ＜0.001 大专及以上 1.274 0.076 9.922 12.645(10.147~15.143) ＜0.001 家庭年收入(元) 0~ 1.000 10 000~ 0.326 0.012 1.205 0.393(-0.246~1.031) 0.228 20 000~ 0.334 0.009 0.855 0.285(-0.369~0.939) 0.393 ≥30 000 0.334 0.043 4.070 1.361(0.705~2.016) ＜0.001
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表 3 甘肃省农民健康素养与SAH的关系[n(%)]
Table 3. The relationship between health literacy and SAH of famers in Gansu Province [n(%)]
健康素养得分(分) 自评健康 合计 好 比较好 一般 比较差 差 ＜20 390(22.9) 514(30.1) 635(37.2) 143(8.4) 24(1.4) 1 706(10.5) 20~ 1 298(26.0) 1 477(29.6) 1 728(34.7) 378(7.6) 102(2.0) 4 983(30.6) 40~ 1 448(27.8) 1 603(30.8) 1 697(32.6) 358(6.9) 106(2.0) 5 212(31.9) 60~ 1 135(29.8) 1 222(32.0) 1 178(30.9) 220(5.8) 58(1.5) 3 813(23.4) ≥80 166(27.9) 191(32.0) 195(32.7) 39(6.5) 5(0.8) 596(3.7) 合计 4 437(27.2) 5 007(30.7) 5 433(33.3) 1 138(7.0) 295(1.8) 16 310(100.0) 注：χ总2＝169.114，χ回归2＝113.971，χ偏2＝55.143，P＜0.001。
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表 4 甘肃省农民健康素养与SAH的中介模型分析
Table 4. Analysis of mediating model between health literacy and SAH among farmers in Gansu Province
变量 方程1(因变量：Y) 方程2(因变量：M) 方程3(因变量：Y) β值 t值 β值 t值 β值 t值 X 0.028 3 3.7611b 0.059 3 7.462 3b 0.024 4 3.251 9b M 0.064 9 8.777 7c 性别 -0.167 5 -11.188 9c -0.002 6 -1.647 -0.167 3 -11.203 6c 民族 -0.042 3 -1.758 8 -0.119 3 -4.700 6c -0.034 5 -1.439 2 年龄 -0.027 2 -41.159 5c 0.000 7 0.980 3 -0.027 2 -41.321 3c 文化程度 0.041 5 2.397 9a 0.124 9 6.834 3c 0.033 4 1.931 5 R2 0.112 7 0.101 6 0.116 9 F(df)值 415.216 9c 34.108 9c 360.465 5c 注：a表示P＜0.05；b表示P＜0.01；c表示P＜0.001；X=健康素养；M=人均收入；Y=SAH；性别：1=男，2=女；民族：1=汉族，2=其它民族。
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表 5 甘肃省农民健康素养与SAH中介效应的bootstrap检验结果
Table 5. Bootstrap results of mediating effect between health literacy and SAH among farmers in Gansu Province
效应类型 效应值 Boot SE Boot 95% CI值 相对中介效应(%) 总效应 0.028 3 0.007 5 (0.005 7~0.035 4) 直接效应 0.024 4 0.007 4 (0.010 2~0.039 0) 86.22 中介效应 0.003 9 0.000 7 (0.002 6~0.005 3) 13.78
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