Inequalities in self-rated health: explanations from different stages of life
Inequalities in self-rated health: explanations from different stages of life
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DOI：
10.1016/s0140-6736(97)11082-0
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发表时间：
1998-04-04
期刊：
影响因子：
168.9
通讯作者：
Manor, O
中科院分区：
文献类型：
--
作者：
Power, C;Matthews, S;Manor, O
背景健康方面的不平等是一个主要的公共健康问题。需要对不同原因的相对重要性有更深入的了解。方法对1958年英国出生队列中5606名男性和5799名女性的健康行为、教育程度、青少年健康、家庭结构和社会支持、工作特征和物质环境等方面的数据进行了跟踪调查。我们通过调整优势比(IV级和V级对I级和II级)来评估不同因素对自评健康的社会阶层差异的贡献。发现33岁时健康状况较差的男性和女性的优势比分别为3.15和2.30，在调整了先前确定的从出生到成年早期的因素后，这两个优势比分别下降到2.06和1.34。对23岁至33岁之间的成人工作特点、物质环境和健康行为进行调整，进一步将优势比降至1.64(男性)和1.11(女性)。大多数因素导致赔率比降低，社会情绪调整、阶级资格和心理社会工作压力尤其重要，对男性来说，其他关键因素是成年吸烟和工作不安全感，而对女性来说，童年时期的住房、成年收入和第一个孩子的年龄是导致健康不平等的唯一原因。解释的范围从早年到成年。政策影响包括缩小物质环境中的社会差异以及在早期生活中获得的个人技能和资源的差异。
Background Inequalities in health are a major public-health concern. A greater understanding is needed on the relative importance of different causes. We investigated the contribution of risk factors identified at different life stages to inequalities in self-rated health.Methods We used data from 5606 men and 5799 women in the 1958 British birth cohort followed-up to age 33 years, on health behaviour, education, adolescent health, family structure and social support, work characteristics, and material circumstances. We assessed the contribution of different factors to social-class differences in self-rated health by adjustment of odds ratios (classes IV and V vs I and II).Findings Odds ratios of poor-rated health at age 33 were 3.15 for men and 2.30 for women, which decreased to 2.06 and 1.34, respectively, after adjustment for previously identified factors from birth to early adulthood. Adjustment for adult work characteristics, material circumstances, and health behaviour between ages 23 years and 33 years further decreased the odds ratios to 1.64 (men) and 1.11 (women). Most factors contributed to the reduction in odds ratios, socioemotional adjustment, class qualifications, and psychosocial job strain were especially important, Additional key factors for men were adult smoking and job insecurity, and for women, housing during childhood, adult income, and age at first child.Interpretation There was no single cause of health inequality at age 33 years. Explanations spanned from early life to young adulthood. Policy implications include reduction of social differences in material circumstances and of differences in individual skills and resources acquired in early life.