Gradient of disability across the socioeconomic spectrum in the United States
Gradient of disability across the socioeconomic spectrum in the United States
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DOI：
10.1056/nejmsa044316
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发表时间：
2006-08-17
影响因子：
158.5
通讯作者：
Guralnik, Jack M.
中科院分区：
文献类型：
--
作者：
Minkler, Meredith;Fuller-Thomson, Esme;Guralnik, Jack M.
背景：尽管人们早已认识到极端贫困与老年人健康状况不佳之间的关系，但很少有人关注调查美国中产阶级和上层收入人群是否存在残疾梯度。我们试图确定 55 岁或以上人群的所有收入范围内功能限制是否存在梯度。 方法：我们从 2000 年人口普查补充调查中获取数据，该调查使用了美国社区调查的方法和问卷，这是一项针对 890,698 个家庭的全国代表性调查，答复率为 95%。我们的样本包括年龄至少 55 岁的 149,000 名男性和 186,675 名女性，其中 32,680 名男性和 48,111 名女性报告患有功能限制（一种严重限制一项或多项基本身体活动的长期状况，例如爬楼梯或举重）。 结果：在 55 岁至 84 岁之间的男性和女性中观察到社会阶层梯度，即使在社会经济阶梯的上层。例如，与生活在贫困线 700% 或以上的 55 岁至 64 岁之间的人相比，同龄但贫困线以下的人报告功能障碍的几率是其六倍。随着收入的增加，优势比下降。 85 岁之前（但不超过 85 岁）存在显着的梯度。结论：我们的研究结果表明，55 岁至 84 岁之间的美国人的功能限制与整个社会经济梯度范围内的社会阶层呈负相关。
BACKGROUND:Although the relationship between extreme poverty and poor health among older adults has long been recognized, less attention has been devoted to investigating whether a gradient in disability exists in the United States among persons with middle-class and upper-class incomes. We attempted to determine whether a gradient in functional limitation exists across the full spectrum of income among persons 55 years of age or older.METHODS:We obtained data from the Census 2000 Supplementary Survey, which used the methods and questionnaire of the American Community Survey, a nationally representative survey of 890,698 households with a response rate of 95 percent. Our sample included 149,000 men and 186,675 women who were at least 55 years of age, of whom 32,680 men and 48,111 women reported having a functional limitation (a long-lasting condition that substantially limited one or more basic physical activities, such as climbing stairs or lifting).RESULTS:A social-class gradient was observed for both men and women between the ages of 55 and 84, a gradient that held true even at the upper rungs of the socioeconomic ladder. For example, in comparison to persons between the ages of 55 and 64 who lived at 700 percent of the poverty line or above, persons of the same age but below the poverty line had six times the odds of reporting a functional limitation. With increasing income, the odds ratio declined. A significant gradient was present up to, but not beyond, the age of 85 years.CONCLUSIONS:Our findings suggest that functional limitation in Americans between the ages of 55 and 84 years is inversely related to social class across the full spectrum of the socioeconomic gradient.