Mối liên quan giữa Bệnh không lây với dịch vụ sức khỏe và các rào cản do xã hội ở người trung niên_ NCD related health services use and barrier differences by social locations of middle aged people in lao PDR BackgroundNoncommunicable diseases (NCD) are on the rise to become one of the major cause of morbidity and mortality of the people in Lao PDR. Due to NCD’s deep impacts on economic and social burden, the importance of prevention and management of NCDs has been acknowledged widely. Limited researches on the need of NCD related health service use, the status of health service utilization, and barriers of service use. This study analyzed the need, the use, and the barriers of NCD related health services in relation of respondents’ social location. AimsTo examine the need of NCD related health service useTo find out the methods and quantity of health service utilizationTo understand the barriers of needed health service useTo investigate the differences of health service use by “social location”, such as gender, age, financial status, and residential place.
NCD related Health Services Use and Barrier Dif erences by Social Locations of Middle Aged peop le in Lao PDR Gunjeong Lee, Kongmany Chaleunvong, Younhee Kang, Minah Kang, Harris Hyun-soo Kim, Kyungok Yi, Yuri Kim, Yookyung Choi, Minjin Koo September 26th- 27th , 2015 Gunjeong Lee, Ph.D Department of Global Health and Nursing, Ewha Womans University, Seoul, Ko rea Background Non-communicable diseases (NCD) are on the rise to become one of the major cause of morbidity and mortality of the people in Lao PDR Due to NCD’s deep impacts on economic and social burden, the importance of preventi on and management of NCDs has been acknowledged widely Background Limited researches on the need of NCD related health service use, the status of health se rvice utilization, and barriers of service use This study analyzed the need, the use, and the barriers of NCD related health services in relation of respondents’ social location Aims To examine the need of NCD related health service use To find out the methods and quantity of health service utilization To understand the barriers of needed health service use To investigate the differences of health service use by “social location”, such as gender, age, financial status, and residential place Methods Survey Study Research Object : Middle aged people (40-59 years old) Period : May 2th – June 3th, 2015 Randomly selected 25 urban villages in district from Vientiane Capital and 25 rural vill ages in district from Vientiane Province Random selected 20 households from each village’s household list Interviewed one member who is 40-59 years old N=997 completed removed 17 due to inappropriate or incomplete answers Final N=979 Methods Variables for this study health service utilization barriers of health service use social locations such as gender, residential area, age, etc current health status and knowledge level of health Statistical Analysis Descriptive statistical methods and subgroup analyses by social location Measure of NCD Definition of NCD: Diagnosed by Medical Doctor having Hypertension, Diabetes, Mellitus, Heart Disease, Cerebro-vascualr Disease, or Cancer Number (N) Percent (%) Diagnosed NCD 250 25.54% No NCD 682 69.66% Don’t know 47 4.80% Total N 979 100% Diagnosed NCD Diagnosed NCD N (Total N=250) % Hypertension 192 76.8% Diabetes Mellitus 63 25.2% 52 20.8% Cerebrovascular Disease (Stroke) 2.4% Cancer 0.8% Heart Disease (Angina, Myocardial infarction, Heart rhythm problem, etc.) 25people (10%) have more than one diagnosed NCDs Diagnosed NCD variable NCD No NCD Don’ know All 25.54% 69.66% 4.80% Male (n=435) 21.38% 73.10% 5.52% Female (n=544) 28.86% 66.91% 4.23% 40-49yr (n=510) 21.76% 74.51% 3.73% 50-59yr (n=469) 29.64% 64.39% 5.97% Rural 25.66% 68.64% 5.70% Urban 25.41% 70.70% 3.89% Lao-tai 26.68% 69.42% 3.90% Hmong-mien 16.05% 71.60% 12.35% Others 22.45% 69.39% 8.16% < primary 31.25% 57.95% 10.80% Primary~ secondary shool 23.46% 73.46% 3.07% ≥ upper secondary school 25.58% 70.35% 4.07% Literate 24.74% 71.31% 3.95% Illiterate 31.36% 57.63% 11.02% Unhealthy 37.62% 57.71% 4.67% Healthy 16.15% 78.95% 4.90% Employee 23.45% 71.72% 4.83% Self-employee 25.83% 69.03% 5.14% Others(Unemployed) 26.16% 70.35% 3.49% (N=979) sex Age Area Ethnic-group Education level Literacy 0.024 0.002 0.402 0.003 0.000 0.000 Health status Work status P-value 0.000 0.877 Usual place for treatment Variable N Total Drug Store Clinic Hospital Community Village No Health Health Place Center Volunteer To go Others 979 11.13% 13.59% 68.64% 2.25% 0.61% 1.33% 2.45% NCD 250 7.20% 20.80% 68.40% 2.00% 0.00% 0.00% 1.60% No NCD 682 11.00% 10.70% 70.97% 1.91% 0.88% 1.61% 2.93% Male 435 14.48% 12.87% 64.83% 3.22% 0.23% 1.38% 2.99% Female 544 8.46% 14.15% 71.69% 1.47% 0.92% 1.29% 2.02% 40-49 510 12.35% 13.92% 64.71% 3.33% 1.18% 1.57% 2.94% 50-59 469 9.81% 13.22% 72.92% 1.07% 0.00% 1.57% 2.94% Lao-tai 847 10.51% 13.93% 69.89% 1.30% 0.71% 0.94% 2.72% Hmong- Mien 81 17.28% 12.35% 56.79% 8.64% 0.00% 3.70% 1.23% Others 49 8.16% 10.20% 69.39% 8.16% 0.00% 4.08% 0.00% < Primary 176 15.91% 12.50% 63.64% 2.84% 0.57% 3.41% 1.14% Primary- lower secondary 456 8.99% 13.38% 70.39% 2.85% 0.88% 1.10% 2.41% ≧ upper secondary 344 11.34% 14.53% 69.19% 1.16% 0.00% 0/58% 3.20% Literacy 861 10.22% 14.05 % 69.57% 1.97% 0.46% 1.05% 2.67% Illiteracy 118 17.80% 14.05 % 61.86% 4.24% 1.69% 3.99% 0.85% Employee 115 8.28% 13.10% 75.86% 0.00% 0.69% 0.00% 2.07% self-employee 662 12.24% 14.80% 65.56% 2.87% 0.60% 1.51% 2.42% Unemployed 172 9.30% 9.30% 74.42% 1.74% 0.58% 1.74% 2.91% Health Unhealthy 428 10.98% 15.89% 67.99% 2.34% 0.47% 0.70% 1.64% Status Healthy 551 11.25% 11.80% 69.15% 2.18% 0.73% 1.81% 3.09% NCD P-value 0.000 Sex 0.014 Age Ethnic group Education 0.011 Literacy Work 0.000 0.0039 0.006 0.221 Status 0.266 Difficulty in getting medical care Experience of difficulty in getting medical care Yes 97 (9.92%) No 882 (10.08%) Reasons of Difficulty to get medical care 56 42 Health Service Use (during last 1yr) Health Service Total NCD No NCD (N=979, % ) (N=250) (N=682) know P-value (N=47) In-Patient 73 7.46% 13.6% 5.4% 4.3% 0.000 Emergency room 85 8.68% 12.8% 7.3% 6.4% 0.027 Out patient 208 21.25% 31.6% 18.2% 10.6% 0.000 Community health center 35 3.58% 6.4% 2.5% 4.3% 0.016 26 2.66% 3.2% 2.6% 0.0% 0.456 Traditional healer 77 7.87% 12.8% 6.6% 0.0% 0.001 Dental care 179 18.32% 18.8% 19.0% 6.4% 0.095 Village health care volunteer Significant differences by subgroup analyses, more use on • • • • • • • Don’t In-patient : Age(50-59 years old) Emergency room : Sex(Female), Area(Urban) Out-patient experiences b: Sex(Female) Community health center services : Area(Rural) Village health care volunteer(or worker) : Sex(Female), Age(40-49 years old), Area(Rural) Traditional healer : Area(Rural) Dental care : Sex(Female), Area(Urban) Drug store use during last month Total NCD No NCD Don’t know (N=979) (n=250) (n=682) (n=47) 1-2 times per month 30.75% 34.00% 29.47% 31.91% Over times per 1mon 17.77% 26.00% 14.96% 14.89% Not used 51.48% 40.00% 55.57% 53.19% Frequency of Drug store Use Significant difference by subgroup analyses, more use for • • Area -rural Health status- Unhealthy P-value 0.000 Medical insurance Having insurance All NCD No NCD Don’t know (N=979) (n=250) (n=682) (n=47) 25.23% 29.72% 29.23% 17.02% P-value 0.088 No Insurance 74.77% 70.28% 70.77% 80.98% Among Having insurance N=246 100% Public Insurance 235 95.5% Private Insurance 12 4.5% Information about NCD Total N=979 NCD No NCD Don’t know P 100% (n=250) (n=50) (n=47) -value Received information 410 41.88% 64.40% 34.90% 23.40% Not received information 527 53.8% 35.60% 78.13% 74.47% Don’t know 0.2% 0.00% 50.00% 2.13% Received Information about? Hypertension Diabetes mellitus Both 404 (41.27%) 340 (34.73%) 331 (33.81%) 0.000 Medical check up Total NCD No NCD (n=250) (n=682) Don’t know (n=47) N % Regular check up 277 28.3% 39.60% 25.07% 14.89% Irregular check up 343 35.0% 49.60% 34.02% 25.53% No medical check up 359 36.7% 20.80% 40.91% 59.57% Pvalue P