云南省民族地区≥65岁老年人接受肺结核主动筛查的意愿及影响因素分析

doi:10.19982/j.issn.1000-6621.20250337

摘要/Abstract

摘要：

目的: 评估云南省民族地区实施老年人肺结核主动筛查策略下肺结核筛查接受意愿及其影响因素,为提升主动筛查质量提供建议。方法: 2023年1月1日至12月31日期间,采用分层随机抽样方法,选取云南省3个民族地区6个县(市)的12个乡镇/社区年龄≥65岁老年人开展肺结核主动筛查接受意愿问卷调查,共发放问卷1399份,收回有效问卷1395份,有效率为99.71%。结果: 92.62%(1292/1395)的老年人愿意接受肺结核症状筛查,94.27%(1315/1395)的老年人愿意接受肺结核相关检查,90.18%(1258/1395)的老年人对于肺结核症状筛查和相关检查均愿意接受。肺结核主动筛查接受意愿显示,其他职业者主动筛查接受意愿是农业劳动者的9.157倍(95%CI:1.242~67.495);购买其他医保者主动筛查意愿是购买城乡居民医保者的4.098倍(95%CI:1.762~9.531);罹患至少1种疾病者主动筛查意愿是未患病者的1.767倍(95%CI:1.198~2.604);知晓“老年人更容易得肺结核”者主动筛查意愿是不知晓者的3.110倍(95%CI:2.101~4.603);家庭年人均医疗支出≤平均水平者的主动筛查意愿低于>平均水平者(OR=0.459,95%CI:0.313~0.674)。结论: 现有政策下云南省民族地区≥65岁老年人群中接受肺结核主动筛查意愿高,应继续结合国家基本公共卫生服务项目在老年人群中开展肺结核主动筛查,提升筛查质量和效率,提高患者发现水平。

关键词: 老年人, 结核, 主动筛查, 问卷调查, 因素分析, 统计学

Abstract:

Objective: This study aims to evaluate the willingness to accept pulmonary tuberculosis (PTB) screening and its influencing factors under the active screening strategy for PTB among the elderly (aged 65 and above) in ethnic minority areas of Yunnan Province, and to provide suggestions for improving quality of active screening in the future. Methods: From January 1 to December 31, 2023, a stratified random sampling questionnaire survey was conducted on the willingness to accept active PTB screening among the elderly aged 65 and above in 12 towns/communities of 6 counties (cities) in 3 ethnic areas of Yunnan Province. A total of 1399 pieces of questionnaire were distributed, and 1395 valid pieces were retrieved, with a valid rate of 99.71%. Results: 92.62% (1292/1395) of the elderly were willing to take PTB symptom screening, 94.27% (1315/1395) were willing to undergo PTB-related examinations, and 90.18% (1258/1395) were willing to accept both. The willingness to accept active PTB screening was presented as follows: The willingness of non-farmers to accept active screening was 9.157 (95%CI: 1.242-67.495) times of that of farmers. The willingness of those who purchased other medical insurance for active screening was 4.098 times of that of those who purchased the medical insurance for urban and rural residents (95%CI: 1.762-9.531). Individuals with at least one disease had a willingness to be screened that was 1.767 (95%CI: 1.198-2.604) times of that of individuals with no diseases. Those who knew that “the elderly are more prone to tuberculosis” had 3.110 (95%CI: 2.101-4.603) times of willingness to actively undergo screening compared with those who were unaware. The willingness for active screening of families with annual per capita medical expenditure less than OR equal to the average level was lower than that of families with annual per capita medical expenditure greater than the average level (OR=0.459, 95%CI: 0.313-0.674). Conclusion: Under the current policy, the willingness of the elderly aged 65 and above in ethnic minority areas of Yunnan Province to undergo active PTB screening is high. Active PTB screening among the elderly should continue to be carried out in combination with The National Basic Public Health Service Project to improve the quality and efficiency of screening and thereby improve the level of patient detection.

Key words: Aged, Tuberculosis, Active screening, Questionnaires, Factor analysis, statistical

中图分类号:

唐顺定, 许琳, 李玲, 寸得娇, 杨蕊. 云南省民族地区≥65岁老年人接受肺结核主动筛查的意愿及影响因素分析[J]. 中国防痨杂志, 2026, 48(1): 49-56. doi: 10.19982/j.issn.1000-6621.20250337

Tang Shunding, Xu Lin, Li Ling, Cun Dejiao, Yang Rui. Analysis of the willingness and influencing factors of receiving active pulmonary tuberculosis screening among the aged 65 and above in ethnic minority areas of Yunnan Province[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 49-56. doi: 10.19982/j.issn.1000-6621.20250337

图/表 4

表1

表2

老年人肺结核主动筛查接受意愿单因素分析

特征	总人数[名 (构成比,%)]		愿意接受主动筛查				不愿意接受主动筛查				χ²值	P值
特征	总人数[名 (构成比,%)]		人数(名)		构成比(%)		人数(名)		构成比(%)		χ²值	P值
性别											1.619	0.203
男性	642(46.02)		586		91.28		56		8.72
女性	753(53.98)		672		89.24		81		10.76
年龄组(岁)											0.012	0.913
≤71	780(55.91)		704		90.26		76		9.74
>71	615(44.09)		554		90.08		61		9.92
民族											0.844	0.358
汉族	477(34.19)		435		91.19		42		8.81
少数民族	918(65.81)		823		89.65		95		10.35
职业											11.593	0.001
农业劳动者	1278(91.61)		1142		89.36		136		10.64
其他职业	117(8.39)		116		99.15		1		0.85
居住地											1.461	0.227
城区	155(11.11)		144		92.90		11		7.10
农村	1240(88.89)		1114		89.84		126		10.16
文化程度											0.298	0.861
小学以下	747(53.55)		672		89.96		75		10.04
小学	411(29.46)		370		90.02		41		9.98
初中及以上	237(16.99)		216		91.14		21		8.86
医疗保险											20.367	<0.001
城乡居民医保	1135(81.36)		1004		88.46		131		11.54
其他医保	260(18.64)		254		97.69		6		2.31
婚姻状况											2.034	0.154
已婚		1009(72.33)		917		90.88		92		9.12
其他		386(27.67)		341		88.34		45		11.66
家庭年人均收入(元)											0.844	0.358
≤8333		724(51.90)		658		90.88		66		9.12
>8333		671(48.10)		600		89.42		71		10.58
家庭年人均医疗支出(元)											19.021	<0.001
≤833		705(50.54)		660		93.62		45		6.38
>833		690(49.46)		598		86.67		92		13.33
罹患疾病数量											6.660	0.010
未患病		370(26.52)		321		86.76		49		13.24
≥1种		1025(73.48)		937		91.41		88		8.59
村卫生室/社区卫生服务站就诊距离(km)											0.001	0.972
≤1.5		721(51.68)		650		90.15		71		9.85
>1.5		674(48.32)		608		90.21		66		9.79
乡镇卫生院/社区卫生服务中心就诊距离(km)											8.407	0.004
≤5		724(51.90)		669		92.40		55		7.60
>5		671(48.10)		589		87.78		82		12.22
县(市、区)级人民医院就诊距离(km)											0.007	0.934
≤25		759(54.41)		684		90.12		75		9.88
>25		636(45.59)		574		90.25		62		9.75
就诊时有无陪同人员											0.618	0.432
有		1009(72.33)		906		89.79		103		10.21
无		386(27.67)		352		91.19		34		8.81
是否曾经患过结核病											3.846	0.146
是		22(1.58)		18		81.82		4		18.18
否		1321(94.69)		1190		90.08		131		9.92
不清楚		52(3.73)		50		96.15		2		3.85
前往人民医院花费时间(min)											0.210	0.646
≤48		698(50.04)		632		90.54		66		9.46
>48		697(49.96)		626		89.81		71		10.19
前往人民医院路费(元)											3.233	0.073
≤25		632(45.30)		560		88.61		72		11.39
>25		763(54.70)		698		91.48		65		8.52
是否知晓老年人更容易得肺结核											38.467	<0.001
是		757(54.27)		717		94.72		40		5.28
否		638(45.73)		541		84.80		97		15.20
合计		1395(100.00)		1258				137

表2

表3

表4

老年人肺结核相关检查接受意愿影响因素的多因素logistic回归分析

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
职业
农业劳动者					1
其他职业	2.215	1.019	4.722	0.030	9.157(1.242~67.495)
医疗保险
城乡居民医保					1
其他医保	1.411	0.431	10.728	0.001	4.098(1.762~9.531)
家庭年人均医疗支出
≤833元					1
>833元	―0.778	0.196	15.774	<0.001	0.459(0.313~0.674)
罹患疾病数量
未患病					1
患至少1种疾病	0.569	0.198	8.262	0.004	1.767(1.198~2.604)
老年人更容易得肺结核
否					1
是	1.134	0.200	32.146	<0.001	3.110(2.101~4.603)

表4

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变量名称	赋值说明
Y肺结核主动筛查接受意愿	症状和检查任一不愿意=0;症状和检查均愿意=1
X₁职业	农业劳动者=1;其他职业=2
X₂婚姻状况	已婚=1;其他=2
X₃医疗保险	城乡居民医保=1;其他医保=2
X₄家庭人均医疗支出	≤833元=1;>833元=2
X₅罹患疾病数量	未患病=1;患至少1种疾病=2
X₆是否曾经患过结核病	是=1;否=2;不清楚=3
X₇前往人民医院所花费路费	≤25元=1;>25元=2
X₈乡镇卫生院/社区卫生服务中心就诊距离	≤5km=1;>5km=2
X₉是否知晓老年人更容易得肺结核	是=1;否=2