Based on the Sixth Health Service Survey in the Tibet Autonomous Region in 2018, the two-week prevalence rate and its influencing factors were analysed. This study showed that the two-week prevalence rate of residents aged 15 years and above in Tibet was 20.1%, which was higher than the rate from the Fifth Health Service Survey in Tibet (10.6%)[12], indicating that health service needs in Tibet were significantly increased. In this study, the two-week prevalence rate and its influencing factors in the Tibet Autonomous Region were studied using the Sixth Health Service Survey from 2018. Our results showed that the two-week prevalence rate in Tibet was influenced by multiple factors. The two-week prevalence rate is an important index for evaluating the utilization of health services. On the one hand, health insurance coverage has increased from 29.7% in 2003 to 97.0% in 2015 in China. Health insurance coverage has reached approximately 95% in Tibet[13,14]. Additionally, the education level and health awareness of Tibetans have improved. Therefore, more residents choose to actively seek medical treatment.
Among the disease systems, the digestive system had the largest proportion of diseases; however, cardiovascular system diseases were prioritized according to national survey results[12], and may be related to food habits (such as special Tibetan dietary habits). The traditional Tibetan diet is almost approximately 60% protein and high in fat[2]. In the traditional Tibetan dietary model, protein and fat provide approximately 60% of the daily energy intake, making food difficult to digest and be absorbed by the human body. Moreover, hypertension was the most common chronic diseases in Tibet, which may be related to the diet and awareness of Tibetans[15,16]. A high salt in diet and insufficient awareness of hypertension, which leads to an increase in medical treatment[17,18]. Nevertheless, in this study, the self-reported prevalence of hypertension was 14.4% among the patients, which was lower than the national level (23.2%)[19]. This indicates inadequate utilization of health services to a certain extent in Tibet.
In this study, we found that the two-week prevalence among females was higher than that among males. The reason may be that women have special physiological periods, namely menstruation, pregnancy, childbirth, puerperium and breastfeeding, which resulted in special needs[20,21]. Compared with men, women had lower immunity and more delicate emotions, making them more likely to pay attention to their own health needs. According to the findings of Anna Ruggieri[22], it appears that differences in hormonal, genetic and environmental factors between males and females may affect the immune response. In addition, females may actively utilize health services because they pay more attention to health than males.
With increasing age, the two-week prevalence rate showed a linearly increasing trend, which was supported by studies[23] that have shown that various kinds of physical diseases gradually increase with increasing age. For most older people, physical and social activities show a downward trend, which weakens the immunity of the body. In addition, most women over 60 are menopausal, and their health might be affected by hormone levels[24]. Older people being more sensitive to illness may promote their use of medical services.
In addition, we found that the two-week prevalence rate may be related to residence, marital status, and employment status. We identified factors that differed between rural and urban residences of two-week prevalence rates. The two-week disease risk of urban residents was higher than that of rural residents, which may be because the education level and health awareness of urban residents were higher than those of farmers and herdsmen[25, 26]. Moreover, the distance between residential areas and clinical areas in agricultural and pastoral areas was relatively farther than in urban areas, which might affect the accessibility of medical treatment to farmers and herdsmen to a certain extent. Therefore, the reported prevalence rate was low, which was similar to the results from Tian, D[27].Compared with married people, the two-week prevalence of widowed and divorced people was higher. The reason may be that the past way of life or environment of people who experience widowhood or divorce, to a certain extent, would be changed. On the other hand, widowed patients were also more likely to be older, and the results were consistent with age. Therefore, the widowed patients may have a certain negative psychological impact on health. A happy marriage and good family care are conducive to reducing the occurrence of illness and accelerating recovery from illness. In different employment situations, unemployment and being laid off were risk factors for two-week illness which is similar to the results from the Fifth National Health Service Survey[12]. To a certain extent, An irregular daily life and realistic pressure are negative factors of illness[28]. As a special social group, school students were at an early life stage, and have relatively low life pressure and regular living habits, and most of them are energetic because of their youth with good physical immunity, so the possibility of two-week illness was low.
There were several limitations in this study. Firstly, it was insufficient to make causal inferences in this cross-sectional study, so we could only provide the possible influencing factors for the two-week illness. Secondly, because the status of illness was self-reported, the actual two-week illness may be underestimated due to recall bias and low diagnosis rate. Thirdly, due to the lack of longitudinal data, we were unable to examine changes in the two-week prevalence rate.