2021―2024年安徽省居民健康素养水平变化趋势及与医疗自付费用的关联

谢建嵘; 符院生; 许德; 王志敏; 夏元睿; 范引光

doi:10.16462/j.cnki.zhjbkz.2025.08.009

2021―2024年安徽省居民健康素养水平变化趋势及与医疗自付费用的关联

doi: 10.16462/j.cnki.zhjbkz.2025.08.009

1.
安徽省疾病预防控制中心健康教育促进所，合肥 230601
2.
安徽医科大学公共卫生学院流行病与卫生统计学系，合肥 230032

基金项目:

大健康研究院健康大数据与群体医学研究所专项资金资助 JKS2022003

详细信息

通讯作者:
范引光，E-mail: fanyinguang@163.com

中图分类号: R193
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出版历程
- 收稿日期: 2025-04-14
- 修回日期: 2025-05-15
- 刊出日期: 2025-08-10

Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses

1.
Department of Health Education, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
2.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China

Funds:

Research Funds of Center for Big Data and Population Health of IHM JKS2022003

More Information

Corresponding author: FAN Yinguang, E-mail: fanyinguang@163.com

摘要

摘要: 目的分析2021―2024年安徽省居民健康素养水平变化趋势及与医疗自付费用的关联，为优化健康促进策略提供依据。方法采用分层多阶段、简单随机与人口规模大小成比例抽样(probability proportionate to size sampling, PPS)相结合的抽样方法，于2021―2024年对安徽省15~69岁常住居民进行健康素养调查。剔除慢性非传染性疾病患者后，采用单因素和多因素logistic回归模型分析健康素养水平与医疗自付费用的关联。结果 2021―2024年安徽省居民健康素养水平分别为27.31%、29.06%、31.09%和32.55%，呈逐年上升趋势(趋势χ² =114.576, P < 0.001)。多因素logistic回归模型分析结果显示，控制混杂变量后，与不具备健康素养组相比，具备健康素养组(OR=0.90, 95% CI: 0.86~0.96)医疗自付费用水平较低，健康素养水平与医疗自付费用呈负相关。在健康素养的不同维度中，3个方面的健康素养与医疗自付费用均呈负相关(均P < 0.05)；6类健康问题素养中科学健康观、基本医疗和健康信息与医疗自付费用呈负相关(均P < 0.05)。结论 2021―2024年安徽省居民健康素养水平稳步提升，但较发达省份仍存差距；居民健康素养水平是影响医疗自付费用的关键因素，健康素养不足常伴有较高的医疗负担。
- 健康素养 /
- 医疗自付费用 /
- 变化趋势
Abstract: Objective To analyze the trend in health literacy levels among residents in Anhui Province from 2021 to 2024 and its correlation with medical out-of-pocket expenses, providing a basis for optimizing health promotion strategies. Methods A stratified multi-stage sampling method combined with simple random sampling and probability proportional to size (PPS) sampling was applied to conduct a health literacy survey among permanent residents aged 15-69 in Anhui Province during 2021-2024. After excluding individuals with chronic diseases, univariate and multivariate logistic regression models were used to analyze the association between health literacy and medical out-of-pocket expenses. Results Health literacy levels among residents in Anhui Province from 2021 to 2024 were 27.31%, 29.06%, 31.09% and 32.55%, respectively, showing an increasing trend (trend χ² =114.576, P < 0.001). The results of the multivariate logistic regression model analysis showed that, after controlling for confounding variables, compared with the group with limited health literacy, the group with adequate health literacy had lower medical out-of-pocket expenses (OR=0.90, 95% CI: 0.86-0.96), presenting a negative association between health literacy level and medical out-of-pocket expenses. Among the different dimensions of health literacy, three aspects of health literacy were negatively associated with medical out-of-pocket expenses (all P < 0.05). Among the six categories of health issue literacy, scientific views of health, basic medical care, and health information were also negatively associated with medical out-of-pocket expenses (all P < 0.05). Conclusions From 2021 to 2024, the health literacy levels among residents in Anhui Province has steadily improved, but there is still a gap compared to developed provinces. Medical out-of-pocket expenses are a key factor affecting the level of health literacy among residents, and insufficient health literacy is often accompanied by higher medical burdens.
- Health literacy /
- Medical out-of-pocket expenses /
- Trend of change

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图 1 2021―2024年安徽省居民总体及3个方面健康素养水平变化趋势

Figure 1. Trends in the overall and three dimensions of health literacy levels among residents in Anhui Province from 2021 to 2024

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图 2 2021―2024年安徽省居民6类问题健康素养水平变化趋势

Figure 2. Trends in the six aspects of health literacy levels among residents in Anhui Province from 2021 to 2024

下载: 全尺寸图片幻灯片

表 1 研究对象基本情况

Table 1. Basic information of respondents

变量 Variable	人数 Number of people	百分比 Percentage/%	变量 Variable	人数 Number of people	百分比 Percentage/%
地区性质 Place of residence			婚姻状况 Marital status
城市 Urban	28 721	46.04	未婚 Unmarried	12 105	19.40
农村 Rural	33 665	53.96	已婚 Married	46 894	75.17
性别 Gender			分居/离异/丧偶 Separated/divorced/widowed	3 387	5.43
男 Male	27 874	44.68	吸烟 Smoking
女 Female	34 512	55.32	是 Yes	13 139	21.06
年龄组/岁 Age group/years			已戒烟 Quit smoking	4 028	6.46
15~ < 35	20 747	33.26	否 No	45 219	72.48
35~ < 55	25 940	41.58	是否患慢性非传染性疾病 Whether suffering from chronic conditions
55~69	15 699	25.16	否 No	48 359	77.52
文化程度 Education level			是 Yes	14 027	22.48
小学及以下 Primary school and below	17 103	27.41	医疗自付费用/元 Medical out-of-pocket expenses/yuan
初中 Junior high school	21 384	34.28	≤1 000	45 994	73.72
高中/高职/中专 Senior high school/vocational high school/secondary technical school	11 440	18.34	＞1 000~＜5 000	10 273	16.47
大专/本科及以上 College/bachelor′s and above	12 459	19.97	≥5 000	6 119	9.81
职业 Occupation			健康自评状况 Self-rated health status
机关/事业单位人员 Government/public institution employee	7 879	12.63	好 Good	38 971	62.47
农民/工人 Farmer/worker	32 638	52.32	一般 Average	19 692	31.56
学生 Student	6 260	10.03	差 Poor	3 723	5.97
其他 Other	15 609	25.02

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表 2 安徽省居民健康素养与医疗自付费用的关联分析

Table 2. Analysis of the association between health literacy and medical out-of-pocket expenses among residents in Anhui Province

变量 Variable	单因素logistic回归分析 Univariate logistic regression analysis		多因素logistic回归分析 Multivariate logistic regression analysis
变量 Variable	OR值 value (95% CI)	P值 value	OR值 value (95% CI)	P值 value
地区性质 Place of residence
城市 Urban	1.00		1.00
农村 Rural	0.90(0.86~0.94)	< 0.001	0.88(0.84~0.93)	< 0.001
性别 Gender
男 Male	1.00		1.00
女 Female	0.64(0.61~0.67)	< 0.001	0.67(0.63~0.72)	< 0.001
年龄组/岁 Age group/years
15~ < 35	1.00		1.00
35~ < 55	0.75(0.71~0.80)	< 0.001	0.79(0.74~0.85)	< 0.001
55~69	0.59(0.56~0.63)	< 0.001	0.95(0.88~1.03)	0.254
文化程度 Education level
小学及以下 Primary school and below	1.00		1.00
初中 Junior high school	0.84(0.69~0.78)	< 0.001	0.86(0.81~0.92)	< 0.001
高中/高职/中专 Senior high school/vocational high school/secondary technical school	0.58(0.54~0.62)	< 0.001	0.88(0.80~0.96)	0.003
大专/本科及以上 College/bachelor′s and above	0.66(0.62~0.71)	< 0.001	0.91(0.83~1.01)	0.068
职业 Occupation
机关/事业单位人员 Government/public institution employee	1.00		1.00
农民/工人 Farmer/worker	1.20(1.12~1.29)	< 0.001	1.07(0.98~1.16)	0.125
学生 Student	0.39(0.35~0.43)	< 0.001	0.54(0.47~0.62)	< 0.001
其他 Other	1.12(1.04~1.21)	0.003	1.07(0.99~1.16)	0.096
婚姻状况 Marital status
未婚 Unmarried	1.00		1.00
已婚 Married	2.25(2.11~2.40)	< 0.001	1.63(1.49~1.79)	< 0.001
分居/离异/丧偶 Separated/divorced/widowed	2.50(2.22~2.81)	< 0.001	1.80(1.57~2.06)	< 0.001
吸烟 Smoking
是 Yes	1.00		1.00
已戒烟 Quit smoking	1.36(1.22~1.52)	< 0.001	1.32(1.18~1.47)	< 0.001
否 No	1.27(1.20~1.35)	< 0.001	1.05(0.97~1.14)	0.213
健康素养 Health literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.81(0.77~0.85)	< 0.001	0.90(0.86~0.96)	< 0.001

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表 3 不同维度健康素养与医疗自付费用关联分析

Table 3. Analysis of the associations between different dimensions of health literacy and medical out of pocket expenses

变量 Variable	单因素分析 Univariate analysis		多因素分析 Multivariate analysis
变量 Variable	OR值 value (95% CI)	P值 value	OR值 value (95% CI)	P值 value
基本知识和理念素养 Basic knowledge and attitudes literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.83(0.80~0.87)	< 0.001	0.94(0.90~0.99)	0.030
健康生活方式与行为素养 Healthy lifestyles and behaviors literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.83(0.79~0.87)	< 0.001	0.93(0.88~0.98)	0.009
基本技能素养 Health-related skills literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.85(0.81~0.89)	< 0.001	0.94(0.89~0.99)	0.017
科学健康观素养 Scientific views of health literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.85(0.81~0.89)	< 0.001	0.95(0.90~0.99)	0.044
传染病防治素养 Infectious diseases prevention and treatment literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.85(0.80~0.89)	< 0.001	0.95(0.90~1.00)	0.063
慢性病防治素养 Chronic diseases prevention and treatment literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.85(0.81~0.89)	< 0.001	0.97(0.92~1.02)	0.279
安全与急救素养 Safety and first aid literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.81(0.77~0.85)	< 0.001	0.96(0.91~1.01)	0.115
基本医疗素养 Primary medical care literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.87(0.82~0.91)	< 0.001	0.94(0.89~0.99)	0.017
健康信息素养 Health information literacy
不具备 Do not possess	1.00		1.00
具备 Possess	0.83(0.79~0.87)	< 0.001	0.93(0.88~0.97)	< 0.003

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参考文献(20)

[1]	U.S. National library of medicine[EB/OL]. (2020-01-20)[2025-03-20]. https://medlineplus.gov/healthliteracy.html.
[2]	Hai YY, Wu WL, Yu LW, et al. Health literacy and health outcomes in China's floating population: mediating effects of health service[J]. BMC Public Health, 2021, 21(1): 691. DOI: 10.1186/s12889-021-10662-7.
[3]	Ma TP, Meng HD, Ye ZQ, et al. Health literacy mediates the association between socioeconomic status and productive aging among elderly Chinese adults in a newly urbanized community[J]. Front Public Health, 2021, 9: 647230. DOI: 10.3389/fpubh.2021.647230.
[4]	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.
[5]	Li YY, Lyu XF, Liang J, et al. The development and progress of health literacy in China[J]. Front Public Health, 2022, 10: 1034907. DOI: 10.3389/fpubh.2022.1034907.
[6]	Eichler K, Wieser S, Brügger U. The costs of limited health literacy: a systematic review[J]. Int J Public Health, 2009, 54(5): 313-324. DOI: 10.1007/s00038-009-0058-2.
[7]	李英华. 2012年中国居民健康素养监测方案简介[J]. 中国健康教育, 2014, 30(6): 563-5. DOI: 10.16168/j.cnki.issn.1002-9982.2014.06.003. Li YH. Introduction of 2012 Chinese residents health literacy monitoring program[J]. Chinese Journal of Health Education, 2014, 30(6): 563-5. DOI: 10.16168/j.cnki.issn.1002-9982.2014.06.003.
[8]	国家统计局. 中国居民及重点人群健康素养监测统计调查制度[EB/OL]. (2022-03-03)[2025-03-02]. https://www.stats.gov.cn/fw/bmdcxmsp/bmzd/202302/t20230215_1907197.html.
[9]	国家卫生计生委办公厅. 《中国公民健康素养——基本知识与技能(2015年版)》[EB/OL]. (2016-01-06)[2025-03-20]. https://www.nhc.gov.cn/xcs/c100123/201601/ca65ae770b254900a6cee62f5a2d6f84.shtml.
[10]	Li L, Li YH, Nie XQ, et al. The association between health literacy and medical out-of-pocket expenses among residents in China[J]. J Public Health, 2024, 32(4): 621-629. DOI: 10.1007/s10389-022-01792-2.
[11]	安徽省卫生健康委员会. 安徽省人民政府关于印发健康安徽行动实施方案的通知[EB/OL]. (2020-01-13)[2025-03-20]. https://wjw.ah.gov.cn/ztzl/shylwstzgg/gjzc1/51991241.html.
[12]	上海市健康促进中心. 2024年上海居民健康素养水平达42.09%, 实现17年连升[EB/OL]. (2025-01-16)[2025-03-20]. https://www.schp.sh.cn/xwzx/mtsd/2948.
[13]	浙江发布. 2024年浙江居民健康素养水平结果公布[EB/OL]. (2025-02-08)[2025-03-20]. https://zjic.zj.gov.cn/ywdh/shjs/202501/t20250126_23212104.shtml.
[14]	刘亚欣, 刘虹妍, 沈阳, 等. 2012―2016年重庆市居民健康素养趋势性及其影响因素[J]. 中华疾病控制杂志, 2020, 24(8): 929-933. DOI: 10.16462/j.cnki.zhjbkz.2020.08.013. Liu YX, Liu HY, Shen Y, et al. Study on the trend of health literacy and its influencing factors in Chongqing, 2012-2016[J]. Chin J Dis Control Prev, 2020, 24(8): 929-933. DOI: 10.16462/j.cnki.zhjbkz.2020.08.013.
[15]	王莉莉, 孙乐成, 高颖, 等. 2019―2022年海南省居民健康素养水平变化情况及其影响因素分析[J]. 中国健康教育, 2024, 40(1): 45-50. DOI: 10.16168/j.cnki.issn.1002-9982.2024.01.009. Wang LL, Sun LC, Gao Y, et al. Analysis on the change of health literacy level and its influencing factors among residents in Hainan Province from 2019 to 2022[J]. Chinese Journal of Health Education, 2024, 40(1): 45-50. DOI: 10.16168/j.cnki.issn.1002-9982.2024.01.009.
[16]	姚丁铭, 吴青青, 徐水洋, 等. 2016―2020年浙江省居民健康素养水平变化趋势研究[J]. 中国预防医学杂志, 2023, 24(2): 150-155. DOI: 10.16506/j.1009-6639.2023.02.011. Yao DM, Wu QQ, Xu SY, et al. The trend of health literacy among residents in Zhejiang, 2016-2020[J]. Chin Prev Med, 2023, 24(2): 150-155. DOI: 10.16506/j.1009-6639.2023.02.011.
[17]	Rasu RS, Bawa WA, Suminski R, et al. Health literacy impact on national healthcare utilization and expenditure[J]. Int J Health Policy Manag, 2015, 4(11): 747-755. DOI: 10.15171/ijhpm.2015.151.
[18]	Haun JN, Patel NR, French DD, et al. Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study[J]. BMC Health Serv Res, 2015, 15: 249. DOI: 10.1186/s12913-015-0887-z.
[19]	Mantwill S, Schulz PJ. Low health literacy associated with higher medication costs in patients with type 2 diabetes mellitus: evidence from matched survey and health insurance data[J]. Patient Educ Couns, 2015: S0738-3991(15)30015-X. DOI: 10.1016/j.pec.2015.07.006.
[20]	朱小林, 郭馨月, 陈颖, 等. 安徽省桐城市综合医院门诊患者健康素养现状及其影响因素研究[J]. 安徽预防医学杂志, 2024, 30(4): 285-290. DOI: 10.19837/j.cnki.ahyt.2024.04.006. Zhu XL, Guo XY, Chen Y, et al. Health literacy status and influencing factors of outpatients in Tongcheng general hospital of Anhui Province[J]. Anhui J Prev Med, 2024, 30(4): 285-290. DOI: 10.19837/j.cnki.ahyt.2024.04.006.