Norm Establishment For Sub-health Measurement Scale(SHMS V1.0)in Chinese Urban Residents And Construction Study Of Influencing-Factor Models For Sub-health Status

PurposeThis study aims to establish the norm of Sub-health Measurement Scale Version 1.0(SHMS V1.0),and clarify the status,influencing factors and mediating effect of sub-health status,in order to provide practical assessment tools and policy recommendations for sub-health prevention.Content1.Evaluation the reliability and validity of SHMS V1.0 for Chinese urban residents.2.Establishment of the norm of SHMS V1.0 for Chinese urban residents.3.Analysis of the status and influencing factors of sub-health status.4.Mediating effect of sub-health for Chinese urban residents.MethodsA large-scale of face-to-face epidemiological survey was carried out in Tianjin city,Hei Longjiang province,Guangdong province,Sichuan province and Gansu province.SAS?SPSS and R software were used for statistical analysis.Using logistic regression to analyze the influencing factors.Nomogram was drawn and C-index,calibration plot and AUC were calculated to evaluate the predictive effect of regression model.Structural equation model was used to analyze the mediating effect.Difference with p<0.05 was statistical significance.ResultsDuring Dec 2017 and Oct 2018,6748 valid samples were collected out of 7339 released.Mean age was 41.40±16.13 year.Male counted for 48.4%.1.Reliability and validity of SHMS V1.0Internal consistency reliability ?=0.922.The split-half coefficients were higher than 0.70.Confirmatory factor analysis revealed better fit results RMR=0.038,GFI=0.980,CFI=0.882,RMSEA=0.028.2.Norm of SHMS V1.0Norm of SHMS V1.0 was established by age and sex.We calculated mean and standard deviation in each age and sex specified group and established mean norm.A percentile norm was established with a 5%spacing.Demarcation norm was finally identified as follows:[0,X-S)divided as disease,[X-S,X+S)classified as sub-health,and[X+S,100]classified as healthy.3.SHS of Chinese urban residentsThe detective rate of general SHS in Chinese urban residents was 66.7%,of the physiological,mental and social SHS were 67.0%,65.5%,and 70.0%,respectively.4.Association analysis of sub-health for Chinese urban residentsFactors associated with general,physical,mental,and social sub-health were 24,19,24 and 16,respectively.Bias corrected C-index were 0.782,0.733,0.767 and 0.734,respectively.5.Mediating effect of sub-health for Chinese urban residentsDirect association of lifestyle factors and general sub-health were-0.110 which were higher than indirect association(-0.051)through internal cause.Only direct association was found for lifestyle factors and physical sub-health.The direct association of lifestyle factors and mental sub-health was 0.060,which was samller than indirect association(-0.099)through internal cause.Only indirect association(-0.3 17)was found for lifestyle factors and social sub-health.Direct association of environmental factors with general sub-health and mental sub-health were 0.200 and 0.150,which were smaller than indirect association(0.348 and 0.462).Direct association of environmental factors and physical sub-health were 0.380,higher than indirect association(0.218).Only indirect association(0.231)was found in the association of environemtnal factors and social sub-health.Mediating effect of parent-child relationship on the association of childhood negative events and adult sub-health:the direct effects of childhood negative events on general,physical and mental sub-health in adulthood were-0.123,-0.112,and-0.105,which were slightly higher than indirect effects through growing parent-child relationships(-0.106,-0.074,-0.104).The direct effect of childhood negative events on social subhealth(-0.075)was slightly lower than that of parent-child relationship(-0.102).The mediating effect of adversity quotient on the association of stressful life events with sub-health:the direct effects of stressful life events on general,physical,mental and social sub-health were-0.367,-0.352,-0.385,and-0.278,which were higher than those of indirect effects(-0.050,-0.047,-0.053,-0.054)through adversity quotient.Conclusions1.SHMS V1.0 scale has high reliability,validity and reactivity and can be used in SHS evaluation of Chinese urban residents.2.According to the norm of SHMS V1.0 scale for Chinese urban residents,SHS can be easily identified.3.Detective rates of general SHS,physical SHS,mental SHS and social SHS for Chinese urban residents are high.4.Sub-health is affected by population and security factors,lifestyle factors,family and environmental factors,personality characteristics,health awareness,experience events and policy environment.5.Mediating effects of internal factors,parent-child relationship,and adversity quotient were found in the association path of SHS.