Unsupervised clustering analysis of comprehensive health status and its influencing factors on women of childbearing age…

Participant sociodemographic characteristics

Among the valid questionnaires, 2,925 questionnaires from participants aged 15–49 years were screened. The average participant age was 32.15 ± 8.61 years, with an approximately equal proportion of urban (58.9%) and rural (41.1%) participants. Most of the participants had a bachelor’s degree or higher (62%) (Table 1).

Table 1 Basic sociodemographic profile of women of childbearing age in Shanxi Province

Health pattern groups

The 2,925 participants were sorted into six clusters, and the centroid of each health mode is shown in Table 2. A total of 1,258 participants (43.0%) were classified into Health Pattern 1, signifying good health status in all five domains along three dimensions, including quality of life, mental health, and illness. A total of 499 (17.1%) participants were classified into Health Pattern 2, signifying a slightly lower quality of life and mental health status, and worse chronic disease status. A total of 288 (9.8%) participants were classified into Health Pattern 3, signifying a slightly lower quality of life and mental health status and worse health status at two weeks prior to the questionnaire. A total of 647 (22.1%) participants were classified into Health Pattern 4, signifying a much lower quality of life and mental health. Meanwhile, 166 (5.7%) participants were classified into Health Pattern 5, signifying the lowest level of quality of life and mental health status. Finally, 67 participants (2.3%) were classified into Health Pattern 6, signifying a slightly lower level of quality of life and mental health status and the worst disease status (Table 2). The scatter plots of the individual health patterns are shown in Fig. 2.

Table 2 Clustered mass centers for each health pattern
Fig. 2

Clustered scatter plot. Visualization of mental health, illness, and self-rated health dimensions of individuals with different health patterns

Health status

The mean SF-12 scale score was 579.88 ± 107.97. In the distribution analysis of the number of people in each Health Pattern by age, education level, income level, and marital status, the distribution of health patterns in the different income groups was roughly the same as the distribution trend of the six types of health patterns in the overall survey population.

The distribution map of the health patterns is shown in Fig. 3. Figure 4a to d illustrate the distribution of health patterns according to income, age, education level, and marriage, respectively. Figure 4c illustrates the distribution of the six health patterns among women of childbearing age categorized into different literacy level subgroups. Notably, there was a significant deviation in the distribution trend of the six health patterns among participants with junior high school education and below (red color block) compared with the overall survey population stratified by education level. Specifically, there was a substantial decrease in the number of participants in Health Pattern 1 and a significant increase in the number of participants categorized into Health Pattern 2. Women with junior high school education and below exhibited a lower proportion of individuals in the three-dimensional (3-D) health pattern and a higher percentage of individuals with disease conditions, particularly chronic diseases, in comparison to participants with higher educational levels. These findings suggest that individuals with lower educational attainment may have a diminished presence in the 3-D health pattern due to a higher prevalence of chronic diseases. In Fig. 4d, women with other marital statuses (divorced or widowed) demonstrated poorer representation in the 3-D health pattern and a higher proportion in Health Pattern 3, indicating that this subgroup represents a smaller portion of the 3-D health pattern population due to a higher prevalence of the two-week disease status.

Fig. 3
figure 3

Participant distribution by health pattern. The number of participants in each health pattern

Fig. 4
figure 4

Health pattern distribution by age, income, culture, and marital status. a The number of participants across different (a) income groups, (b) age groups, (c) education level groups, and (d) marriage groups in six health patterns

Correlations and regressions

Table 3 presents the final multivariate logistic regression data. Considering Health Pattern 1 (optimal health pattern) and Health Pattern 2 (poor chronic disease status), participants with education levels of senior high school (OR = 0.462, 95% CI: 0.283–0.753), tertiary (OR = 0.520, 95% CI: 0.312–0.865), bachelor’s degree (OR = 0.516, 95% CI: 0.329–0.810), and postgraduate degree and higher education (OR = 0.584, 95% CI: 0.380–0.896) showed better performance in the 3-D health pattern than that showed by those with education levels of junior high school and below. A lean meat diet was associated with a higher risk of poor health status than that observed with a balanced diet (OR = 1.455, 95% CI: 1.044–2.027). Compared with those who never had a gynecological examination, those who had regular gynecological examinations (OR = 1.842, 95% CI: 1.313–2.585), irregular gynecological examinations (OR = 1.469, 95% CI: 1.039–2.076), and gynecological examination only when physical abnormalities were found (OR = 1.532, 95% CI: 1.039–2.076) had better performance in the 3-D health pattern. Meanwhile, women with unhealthy family members were associated with a higher risk of poor health status than that observed in women with healthy family members (OR = 1.473, 95% CI: 1.185–1.831). Women with poor access to health care (OR = 1.452, 95% CI: 1.004–2.101) showed worse performance in the 3-D health pattern than that showed by women with better access to health care.

Table 3 Multivariate logistic regression analysis of correlates of health status of women of childbearing age

A comparison between Health Pattern 1 (optimal health pattern) and Health Pattern 3 (poorer health in the last two weeks) populations showed that younger age (< 27 years: OR = 0.434, 95% CI: 0.302–0.625; 27–38 years: OR = 0.551, 95% CI: 0.397–0.764) was associated with higher health protection. A lean meat diet was associated with a higher risk of poor health status than that observed with a balanced diet (OR = 1.669, 95% CI: 1.128–2.470). A preference for sweeter cooking was associated with a higher risk of poor health status compared with that observed with moderate cooking preference (OR = 2.231, 95% CI: 0.299–4.110). Regarding social support, participants with poor social support (OR = 4.5363, 95% CI: 1.448–14.206), general support (OR = 3.082, 95% CI: 1.472–6.453), and relative support (OR = 2.599, 95% CI: 1.275–5.299) showed worse performance in the 3-D health pattern than that showed by those with satisfactory social support. A poor hand washing habit was associated with a higher risk of poor health status than that observed with a good hand washing habit (OR = 1.693, 95% CI: 1.126–2.546).

Comparison between Health Pattern 1 (optimal health pattern) and Health Pattern 4 (poor self-rated health) populations showed that a negative attitude toward breast cancer prevention was associated with a higher risk of poor health status than that observed with a positive attitude (OR = 1.235, 95% CI: 1.012–1.508). In addition, participants with poor social support (OR = 4.577, 95% CI: 2.002–10.467), general support (OR = 3.167, 95% CI: 1.921–5.221), and relative support (OR = 3.184, 95% CI: 1.349–3.538) showed worse performance in the 3-D health pattern than that showed by those with satisfactory social support.

Comparison between the Health Pattern 1 (optimal health pattern) and Health Pattern 5 (worst self-rated health) populations showed that a preference for sweeter cooking was associated with a higher risk of poor health status than that observed with a moderate cooking preference (OR = 2.337, 95% CI: 1.137–4.799). Participants with poor social support (OR = 9.310, 95% CI: 2.380–36.423), general support (OR = 5.070, 95% CI: 1.776–14.477), and relative support (OR = 1.974, 95% CI: 1.242–3.135) showed worse performance in the 3-D health pattern than that showed by those with satisfactory social support. Women with poor access to health care (OR = 2.178, 95% CI: 13.960–3.399) showed worse performance in the 3-D health pattern than that showed by those with better access to health care.

In comparing the Health Pattern 1 (optimal health pattern) and Health Pattern 6 (poor prevalence of both illness and chronic disease in the last two weeks) populations, being < 27 years old was associated with higher health protection (OR = 0.403, 95% CI: 0.193–0.841). Having regular gynecological examinations (OR = 2.716, 95% CI: 1.154–6.394) and poor hand washing habits (OR = 2.047, 95% CI: 1.000–4.229) were associated with a higher risk of poor health.

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