社会经济地位对心力衰竭患者就医延迟行为影响及机制研究

doi:10.12183/j.scjpm.2026.0767

摘要/Abstract

摘要： 目的探讨社会经济地位对心衰住院患者就医延迟行为影响及中介机制,分析健康素养、社会支持、应对方式的中介效应,为制定干预策略提供重要依据。方法纳入2024年1月至2025年10月于临泉县某医院就诊的232例心力衰竭患者。收集患者社会经济地位（经主成分分析提取综合指数）、就医延迟时间（以中位数36.5 h为界值分组）、一般临床资料及预后信息;采用慢性病患者健康素养量表（HLSCP）、社会支持评定量表（SSRS）、医学应对方式问卷（MCMQ）评估健康素养、社会支持及应对方式。以社会经济地位综合指数为自变量、就医延迟为因变量、健康素养、社会支持及应对方式为中介变量,采用PROCESS模型4进行中介效应分析。结果共纳入229例心力衰竭患者,就医延迟中位时间37.00 h,延迟组112例（48.9%）。延迟组社会经济地位综合指数[-0.35（-1.02,0.21）]低于及时组[0.18（-0.41,0.79）]（P<0.01）。多因素分析显示,社会经济地位综合指数每增加1个单位,就医延迟风险降低34.4%（OR=0.656,95% CI：0.527~0.818）。中介效应分析表明,社会经济地位综合指数对就医延迟的总效应为-0.182,直接效应为-0.123,总间接效应为-0.059,中介占比32.4%。预后方面,延迟组住院天数更长,30 d全因再入院率、心衰相关再入院率及病死率均高于及时组（P<0.05或P<0.01）。结论低社会经济地位可直接及间接（经健康素养、社会支持及屈服应对方式中介,中介占比32.4%）增加心力衰竭患者就医延迟风险,进而延长住院时间、升高再入院及死亡率。临床应重点关注低社会经济地位患者,通过提升健康素养、加强社会支持、改善应对方式降低延迟、改善预后。

关键词: 心力衰竭, 就医延迟, 社会经济地位, 健康素养, 社会支持, 应对方式

Abstract: Objective To investigate the impact of socioeconomic status (SES) on treatment-seeking delay behavior among hospitalized patients with heart failure (HF) and to explore the mediating mechanisms of health literacy, social support, and coping styles, thereby providing an evidence-based foundation for developing targeted intervention strategies. Methods A total of 232 patients diagnosed with HF and admitted to a hospital in Linquan Country between January 2024 and October 2025 were enrolled in this study. Data were collected on patients' SES (a composite index derived from principal component analysis), treatment-seeking delay time (dichotomized based on a median of 36.5 hours), general clinical characteristics, and prognostic outcomes. Health literacy, social support, and coping styles were assessed using the Health Literacy Scale for Chronic Patients (HLSCP), the Social Support Rating Scale (SSRS), and the Medical Coping Modes Questionnaire (MCMQ), respectively. A mediation analysis was conducted using PROCESS model 4, with the SES composite index as the independent variable, treatment-seeking delay as the dependent variable, and health literacy, social support, and coping styles as mediating variables. Results The final analysis included 229 HF patients. The median treatment-seeking delay time was 37.00 hours, with 112 patients (48.9%) classified into the delay group. The SES composite index was significantly lower in the delay group [-0.35 (-1.02, 0.21)] compared to the timely treatment group [0.18 (-0.41, 0.79)] (P<0.01). Multivariate analysis revealed that for each unit increase in the SES composite index, the risk of treatment-seeking delay decreased by 34.4% (OR=0.656, 95% CI: 0.527-0.818). The mediation analysis indicated a total effect of SES on treatment-seeking delay of -0.182, with a direct effect of -0.123 and a total indirect effect of -0.059, accounting for 32.4% of the total effect. Regarding prognosis, the delay group exhibited a longer length of hospital stay and significantly higher rates of 30-day all-cause readmission, HF-related readmission, and mortality compared to the timely treatment group (P<0.05 or P<0.01). Conclusion Lower socioeconomic status is associated with an increased risk of treatment-seeking delay in patients with heart failure. This relationship is both direct and indirect, with the indirect pathway being mediated by health literacy, social support, and a resignated coping style, which collectively account for 32.4% of the total effect. This delay subsequently contributes to prolonged hospitalization, elevated readmission rates, and higher mortality. Clinical practice should prioritize patients with low SES, implementing interventions aimed at enhancing health literacy, strengthening social support, and improving coping strategies to mitigate treatment-seeking delays and improve patient outcomes.

Key words: Heart failure, Treatment-seeking delay, Socioeconomic status, Health literacy, Social support, Coping style

中图分类号:

R541.6

金超杰, 蒋卉, 李秋丽. 社会经济地位对心力衰竭患者就医延迟行为影响及机制研究[J]. 华南预防医学, 2026, 52(7): 767-773.

Jin Chaojie, Jiang Hui, Li Qiuli. Impact of socioeconomic status on delays in seeking medical care among patients with heart failure: A study of underlying mechanisms[J]. South China Journal of Preventive Medicine, 2026, 52(7): 767-773.

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