老人保健法による健診事業に関する研究 : ロジスティック回帰分析を用いた健康診査事業実施方法と受診率の解析

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A survey on health services provided in accordance with the Health Service Law for the Aged was conducted in 3, 278 cities, wards, towns, and villages throughout Japan in May 1985. Responses were returned from 2, 645 districts and data on beneficiaries of these health services in 2, 625 districts became available. Because the exact number of people constituting the subjects of health services could not be obtained, the service-acceptance rate was calculated by the number of people utilizing the services divided by the those in the population who were at least 40 years old. The service-acceptance rate was affected by both the size of the population of the local community and the methods of implementation of health services. Therefore, the mutual effects of population size and service methods were corrected by logistic regression analysis to find the relationship between methods of implementing health services and the response rate of the public in accepting the services. The service-acceptance rate was divided into two categories: one less than 30% and the other 30% and over. Odds ratios were calculated for an acceptance ratio of 30% and over.The results were summarized as follows:1. In the jurisdictions where the local organizations cooperated in notifying citizens about the results of their general health examination, in comparison with the areas where there was no cooperation, the odds ratio was found to be 2.40. A similar comparison was made between the communities with local cooperation for notification of a general health examination and those communities without it. The odds ratio for the former was found to be 1.66. It was concluded that the role of the local organization is significant in promoting citizens acceptance of health examinations and it is important to create a fertile environment to nurture active regional organizations.2. In the local communities where multiple health examinations were conducted simultaneously, in comparison with the communities where they were not, the odds ratio of the former was calculated to be 2.16, showing a correlation with high response rates. We concluded that the organizations in charge must conduct further studies to organize plans for examinations that are most suitable for the individual area.3. The areas where sound arrangements were made to bring physicians from organizations for health examination to participate in the general health examination were compared with the areas without such arrangements. The odds ratio of the former was found to be 1.65, showing a relationship with high service-acceptance rates. It was concluded that mass examination with maximum efficacy will aid in improving health-service acceptance rates, compared with individual examinations.4. The communities which held special meeting for their citizens to explain the results of the general health examination were compared with those communities which did not. The odds ratio of the former was computed to be 1.59, showing a correlation with the high acceptance ratio. Meeting to explain health data and other follow-up health education were considered important in achieving prevention of diseases of the aged, the primary purpose of health services.5. The communities where citizens were required to bear the expense of general health examinations were compared with those communities where free services were offered. The odds ratio of the former was found to be 0.53, showing a correlation with low response rates. The availability of free health examinations may be considered significant in motivating citizens to accept the services. On the other hand, such a system may have a negative effect in nurturing individual awareness of ones own health care. Therefore the question should be studied in the context of total health care.
日本衛生学会の論文

老人保健法による健診事業に関する研究 : ロジスティック回帰分析を用いた健康診査事業実施方法と受診率の解析

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