国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (3): 380-389.doi: 10.7518/gjkq.2025056

• 论著 • 上一篇    

四川省65~74岁老年人口腔卫生服务利用状况及影响因素

杨惠宇1(),邓雅兰1,任世睿2,王诗萌3,蔡和1,程立1,胡涛1()   

  1. 1.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;口腔医学+前沿医学创新中心 四川大学华西口腔医院预防口腔科 成都 610041
    2.厦门市口腔疾病诊疗重点实验室 厦门医学院附属口腔医院牙体牙髓病科 厦门 361008
    3.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;口腔医学+前沿医学创新中心 四川大学华西口腔医院口腔黏膜病科 成都 610041
  • 收稿日期:2024-06-07 修回日期:2024-10-29 出版日期:2025-05-01 发布日期:2025-04-30
  • 通讯作者: 胡涛
  • 作者简介:杨惠宇，博士，Email：505967357@qq.com
  • 基金资助:
    国家重点研发计划(2023YFC3605600);国家自然科学基金(72104162);四川大学华西口腔医院临床研究项目(LCYJ-ZD-202301)

Utilization and influencing factors of oral health services among elderly people aged 65-74 years in Sichuan Pro-vince, China

Huiyu Yang1(),Yalan Deng1,Shirui Ren2,Shimeng Wang3,He Cai1,Li Cheng1,Tao Hu1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Frontier Innovation Center for Dental Medicine Plus & Dept. of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.Dept. of Cariology and Endodontics, Stomatological Hospital of Xiamen Medical College & Xiamen Key Laboratory of Stomatological Diseases Diagnosis and Treatment, Xiamen 361008, China
    3.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Frontier Innovation Center for Dental Medicine Plus & Dept. of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-06-07 Revised:2024-10-29 Online:2025-05-01 Published:2025-04-30
  • Contact: Tao Hu
  • Supported by:
    National Key Research and Development Program of China(2023YFC3605600);National Natural Science Foundation of China(72104162);Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ-ZD-202301)

RichHTML

0

PDF (PC)

3

摘要：

目的 了解四川省65~74岁老年人口腔卫生服务利用状况，评估其影响因素，为老年口腔保健政策提供参考和依据。 方法 利用四川省第4次全国口腔流行病学调查的数据，以安德森模型为理论框架，通过描述性统计、卡方检验、多元Logistic回归、结构方程模型分析老年人口腔卫生服务利用状况及其影响因素。 结果 共744位老年人参与了调查。过去12个月内口腔卫生服务的利用率为24.1%，且以咨询、预防为目的的仅占其中的8.4%。多元Logistic回归分析显示：教育水平、居住地、自我口腔健康评估、刷牙频率、剩余牙齿数量均能影响口腔卫生服务利用。结构模型分析显示：教育水平越低、居住在乡村、刷牙频率越低、牙齿数目≥20颗、自我口腔健康评估越好的老年人口腔卫生服务利用率越低。 结论 四川省65~74岁老年人口腔卫生服务利用率偏低，大部分以治疗为目的，受教育水平、居住地、自我口腔健康评估、刷牙频率、牙齿数目的影响。

关键词: 口腔卫生服务, 安德森模型, 老年人, 结构方程模型, 回归分析

Abstract:

Objective To understand the utilization of oral health services among elderly individuals aged 65-74 years in Sichuan Province, China; evaluate the influencing factors; and provide references for elderly oral health care policies. Methods Data from the Fourth National Oral Health Survey in Sichuan Province were used. The Anderson model was applied as a theoretical framework. Descriptive statistics, chi-square tests, multiple logistic regression, and structural equation modeling were used to analyze the utilization of oral health services and their influencing factors among elderly individuals. Results A total of 744 elderly individuals participated in the survey. The utilization rate of oral health services in the past 12 months was 24.1%, with only 8.4% of those pertaining to consultation and prevention. Multivariate logistic regression analysis revealed that education level, place of residence, self-assessment of oral health, brushing frequency, and the number of remaining teeth influenced the utilization of oral health services. Structural model analysis indicated that low education le-vels, rural residence, low brushing frequency, the presence of 20 or more teeth, and good self-assessment of oral health were associated with low utilization rates of oral health services among elderly individuals. Conclusion The utilization rate of oral health services among elderly individuals aged 65-74 years in Sichuan Province is relatively low, with most services being for treatment purposes. Utilization is influenced by education level, place of residence, self-assessment of oral health, brushing frequency, and the number of teeth.

Key words: oral health services, Anderson model, elderly people, structural equation model, regression analysis

中图分类号: 

  • R780.1

图 1

基于安德森模型的老年人口腔卫生服务利用概念模型"

表 1

变量分类及赋值"

变量赋值
性别1=女，2=男
教育程度1=高中及以上，2=初中，3=小学，4=未受教育
态度和知识1=低（0~6分），2=高（6~10分）
居住地1=城镇，2=乡村
家庭年收入1=高，2=较高，3=较低，4=低
自我口腔健康评估1=差，2=一般，3=好
抽烟状况1=抽烟，2=已戒烟，3=不抽烟
刷牙频率1=≥2次/d，2=1次/d，3=<1次/d，4=从不刷牙
饮食习惯1=差（≤9分），2=好（10~17分）
牙齿数目/颗1=<20，2=≥20

表 2

老年人口腔卫生服务利用现状"

调查项目例数百分比/%
口腔卫生服务利用
从未19125.7
>12个月37450.3
≤12个月17924.1
口腔卫生服务利用原因
咨询检查121.6
预防30.4
治疗16422.0
从未使用56575.9

表　3

老年人口腔卫生服务利用影响因素的 χ2 检验"

变量分类口腔卫生服务利用χ2值P值
从未>12个月≤12个月
性别女93196930.7340.693
男9817886
教育水平未受教育47472931.280<0.001
小学11019286
初中198130
高中及以上155434
态度和知识低109202950.6900.708
高8217284
居住地乡村1361937534.182<0.001
城镇55181104
家庭年收入低41102414.1910.651
较低6612557
较高375732
高479049
自我口腔健康评估好65843810.9450.027
一般6615575
差6013566
抽烟状况不抽烟1202431212.7210.606
已戒烟265328
抽烟457830
饮食习惯好1753391600.5450.761
差163519
刷牙频率从不3035640.641<0.001
<1次/d374214
=1次/d8217579
≥2次/d4212280
牙齿数目/颗≥20191003123.327<0.001
<20172274148

表 4

老年人口腔卫生服务利用影响因素的Logistic回归分析结果"

变量分类参考组>12个月≤12个月
OR95%CIOR95%CI
教育水平小学未受教育1.5980.962~2.6541.0200.566~1.838
初中3.4961.745~7.002***1.4370.647~3.192
高中及以上2.4441.108~5.388*1.5450.652~3.662
居住地城镇乡村1.7941.145~2.811*2.1611.298~3.596**
自我口腔健康评估一般好1.5370.971~2.4341.7291.002~2.982*
差1.8081.120~2.918*2.2161.260~3.898**
刷牙频率<1次/d从不刷牙1.4180.686~2.9312.4490.813~7.373
=1次/d2.1881.145~4.183*5.2331.951~14.037**
≥2次/d2.1161.026~4.3667.3542.599~20.808***
牙齿数目/颗<20≥204.6202.603~8.201***2.8021.439~5.456**

图2

老年人口腔卫生服务利用的结构方程模型"

表 5

模型标准化回归权重和统计学检验结果"

变量βSE偏差校正的95%CIP值
下限上限
教育水平居住地0.4180.0310.3580.4780.002
刷牙频率0.3370.0290.2770.3930.002
牙齿数目-0.0700.018-0.106-0.0370.002
自我口腔健康评估-0.0450.037-0.1180.0280.195
口腔卫生服务利用-0.1530.036-0.223-0.0850.001
居住地刷牙频率0.3660.0310.3030.4240.002
牙齿数目-0.1160.035-0.190-0.0480.003
自我口腔健康评估-0.0150.041-0.0920.0700.739
口腔卫生服务利用-0.1750.038-0.243-0.0940.003
刷牙频率牙齿数目-0.1170.046-0.204-0.0240.009
自我口腔健康评估-0.1030.041-0.185-0.0310.007
口腔卫生服务利用-0.1590.039-0.235-0.0800.002
牙齿数目自我口腔健康评估0.1060.0350.0380.1720.004
口腔卫生服务利用-0.1150.032-0.180-0.0530.002
自我口腔健康评估口腔卫生服务利用-0.0970.035-0.165-0.0300.008

表 6

结构模型变量之间的总效应、直接效应和间接效应"

变量效应效应值
教育水平居住地刷牙频率牙齿数目自我口腔健康评估
居住地总0.418**
直接0.418**
间接无
刷牙频率总0.337**0.366**
直接0.184**0.366**
间接0.153**无
牙齿数目总-0.070**-0.116**-0.117**
直接无-0.073-0.117**
间接-0.070**-0.043**无
自我口腔健康评估总-0.045-0.015-0.103**0.106**
直接-0.0200.031-0.090*0.106**
间接-0.025-0.045**-0.012**无
口腔卫生服务利用总-0.153**-0.175**-0.159**-0.115**-0.097**
直接-0.053-0.122**-0.181**-0.105**-0.097**
间接-0.100**-0.053**0.022**-0.010**无
1 任泽平. 中国老龄化报告[J]. 发展研究, 2023: 40(2): 22-30.
Ren ZP. China aging report[J]. Dev Res, 2023, 40(2): 22-30.
2 Petersen PE, Kandelman D, Arpin S, et al. Global oral health of older people: call for public health action[J]. Community Dent Health, 2010, 27(4 ): 257-267.
3 Crocombe LA, Broadbent JM, Thomson WM, et al. Impact of dental visiting trajectory patterns on clinical oral health and oral health-related quality of life[J]. J Public Health Dent, 2012, 72(1): 36-44.
4 Talakey AA, Bernabé E. Long-term regular dental attendance and tooth retention among British adults: a cross-sectional analysis of national survey data[J]. Int J Dent Hyg, 2019, 17(1): 64-70.
5 Reda SF, Reda SM, Thomson WM, et al. Inequality in utilization of dental services: a systematic review and meta-analysis[J]. Am J Public Health, 2018, 108(2): e1-e7.
6 Hall JP, LaPierre TA, Kurth NK. Oral health needs and experiences of medicaid enrollees with serious mental illness[J]. Am J Prev Med, 2018, 55(4): 470-479.
7 Kovács N, Liska O, Idara-Umoren EO, et al. Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: a multilevel analysis[J]. PLoS One, 2023, 18(6): e0286192.
8 冯希平. 口腔预防医学[M]. 7版. 北京: 人民卫生出版社, 2020: 143-144.
Feng XP. Preventive dentistry[M]. 7th ed. Beijing: People’s Medical Publishing House, 2020: 143-144.
9 Pilotto LM, Celeste RK. Contextual determinants for use of dental services according to different healthcare financing systems: Andersen’s model[J]. Community Dent Oral Epidemiol, 2022, 50(2): 99-105.
10 Herkrath FJ, Vettore MV, Werneck GL. Utilisation of dental services by Brazilian adults in rural and urban areas: a multi-group structural equation analysis using the Andersen behavioural model[J]. BMC Public Health, 2020, 20(1): 953.
11 Latham-Mintus K, Vowels A, Chavan S. Neighborhood disorder, social ties, and preventive healthcare utilization among urban-dwelling older adults[J]. J Aging Health, 2020, 32(10): 1387-1398.
12 Andersen RM. National health surveys and the behavioral model of health services use[J]. Med Care, 2008, 46(7): 647-653.
13 卢珊, 李月娥. Anderson医疗卫生服务利用行为模型: 指标体系的解读与操作化[J]. 中国卫生经济, 2018, 37(9): 5-10.
Lu S, Li YE. Anderson’s the behavioral model of health services use: interpretation and operationali-zation of index system[J]. Chin Health Econ, 2018, 37(9): 5-10.
14 Baskaradoss JK, Geevarghese A. Utilization of dental services among low and middle income pregnant, post-partum and six-month post-partum wo-men[J]. BMC Oral Health, 2020, 20(1): 120.
15 Drachev SN, Puriene A, Aleksejuniene J, et al. Pre-valence of and factors associated with dental service utilization among early elderly in Lithuania[J]. BMC Health Serv Res, 2022, 22(1): 16.
16 邓仁丹, 万洋, 王桂花, 等. 中国不同地区中老年人门诊服务利用及影响因素研究[J]. 现代预防医学, 2022, 49(17): 3164-3169, 3186.
Deng RD, Wan Y, Wang GH, et al. Outpatient service utilization and influencing factors among middle-aged and elderly people in different regions of China[J]. Mod Prev Med, 2022, 49(17): 3164-3169, 3186.
17 Lu HX, Tao DY, Lo ECM, et al. The 4th national oral health survey in the mainland of China: background and methodology[J]. Chin J Dent Res, 2018, 21(3): 161-165.
18 齐小秋. 第三次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2008: 34.
Qi XQ. The third national oral health epidemiological survey report[M]. Beijing: People’s Medical Publishing House, 2008: 34
19 Wang LY, Cheng L, Yuan B, et al. Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study[J]. BMJ Open, 2017, 7(9): e016557.
20 Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme[J]. Community Dent Oral Epidemiol, 2005, 33(2): 81-92.
21 杨阳, 杨墨轩, 钱晓烨, 等. 健康中国视域下四川省口腔医疗人力资源配置现状[J]. 中国卫生资源, 2023, 26(5): 573-581.
Yang Y, Yang MX, Qian XY, et al. Current situation of human resources allocation of stomatology in Sichuan Province from the perspective of healthy China[J]. Chin Health Resour, 2023, 26(5): 573-581.
22 Xu MR, Cheng ML, Gao XL, et al. Factors associa-ted with oral health service utilization among adults and older adults in China, 2015-2016[J]. Community Dent Oral Epidemiol, 2020, 48(1): 32-41.
23 Galvão MHR, Medeiros AA, Roncalli AG. Using Andersen’s behavioural model to examine indivi-dual and contextual factors associated with dental service utilization in Brazil[J]. Community Dent Oral Epidemiol, 2023, 51(5): 746-754.
24 Andrade FB, Antunes JLF, Andrade FCD, et al. Education-related inequalities in dental services use among older adults in 23 countries[J]. J Dent Res, 2020, 99(12): 1341-1347.
25 De Souza VGL, Herkrath FJ, Garnelo L, et al. Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: a cross-sectional household-based survey[J]. PLoS One, 2022, 17(11): e0277845.
26 Peres MA, MacPherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge[J]. Lancet, 2019, 394(10194): 249-260.
27 Cheng YT, Cheng L, Zhu FZ, et al. New measure of functional tooth loss for successful oral ageing: a cross-sectional study[J]. BMC Geriatr, 2023, 23(1): 859.
28 中华人民共和国国家卫生健康委员会办公厅. 健康口腔行动方案(2019—2025年)[EB/OL]. [2024-05-13]. .
Office of National Health Commission of the People’s Republic of China. Action plan for healthy oral health (2019-2025)[EB/OL]. [2024-05-13]. .
29 叶海春, 李丽. 基于CHARLS数据中老年人口腔卫生服务利用现状及影响因素分析[J]. 中国公共卫生, 2021, 37(1): 19-23.
Ye HC, Li L. Status and influencing factors of oral health service utilization among middle-aged and elderly residents: an analysis on CHARLS data[J]. Chin J Public Health, 2021, 37(1): 19-23.
30 Li CF, Yao NA, Yin AT. Disparities in dental healthcare utilization in China[J]. Community Dent Oral Epidemiol, 2018, 46(6): 576-585.
[1] 黎静, 陆倩, 刘星辰, 史宗道. 成都市敬老院老年人口腔健康认知、行为的调查分析[J]. 国际口腔医学杂志, 2017, 44(2): 144-147.
[2] 邓岳佳1,王陈兵1,张曦木1,岳兆国1,刘云坤1,金震宁1,赵曼2. 赫尔老年人口腔健康评价指数与口腔健康影响程度量表评价中国西南地区农村中老年人口腔生存质量的对比研究[J]. 国际口腔医学杂志, 2016, 43(6): 632-635.
[3] 陈琦. 影响腺样囊性癌预后的多因素回归分析[J]. 国际口腔医学杂志, 2015, 42(5): 531-534.
[4] 陈哂媛1，巢永烈1，邓咏梅2，陈超3，李苑1，张书垣1. 成都市老年人可摘局部义齿戴用情况和修复效果调查[J]. 国际口腔医学杂志, 2010, 37(4): 396-399.
[5] 李杨, 张晔, 邹静, 尹菁菁, 康德英. 厦门市3~6 岁儿童患龋危险因素分析[J]. 国际口腔医学杂志, 2009, 36(6): 635-638，642.
[6] 郭斌1，谢思静2，安振梅3，阙克华1，杨帆1，刘静1，周学东1. 老年2 型糖尿病患者唾液分泌率及其葡萄糖的质量浓度分析[J]. 国际口腔医学杂志, 2008, 35(5): 494-494～496.
[7] 郭斌,刘静,杨帆,谢思静,阙克华,张琼,. 老年患者牙科焦虑症的调查分析[J]. 国际口腔医学杂志, 2007, 34(03): 162-164.
[8] 陈小晖. 短牙弓治疗法在老年人牙列缺损修复中的应用[J]. 国际口腔医学杂志, 2000, 27(06): -.
[9] 陈小晖. 老年人固定义齿修复的特点[J]. 国际口腔医学杂志, 1999, 26(01): -.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!