Income inequality, mortality, and self rated health: meta-analysis of multilevel studies.
Income inequality, mortality, and self rated health: meta-analysis of multilevel studies.
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DOI：
10.1136/bmj.b4471
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发表时间：
2009-11-10
期刊：
影响因子：
--
通讯作者：
Yamagata Z
中科院分区：
文献类型：
--
作者：
Kondo N;Sembajwe G;Kawachi I;van Dam RM;Subramanian SV;Yamagata Z
目的定量评价收入不平等与健康的关系。设计随机效应荟萃分析，计算前瞻性队列研究中后续死亡率的总体相对风险，以及横断面研究中自评健康状况较差的总体比值比。数据来源PubMed、ISI Web of Science和国家经济研究局数据库。审查方法同行评议的论文与多层次的数据。结果共纳入9个队列研究的59 509 857例受试者和19个横断面研究的1 280 211例受试者。基尼系数每增加0.05个单位，总体队列相对风险和横断面比值比（95%置信区间）分别为1.08（1.06至1.10）和1.04（1.02至1.06）。荟萃回归分析显示，在基尼系数较高（≥0.3）的研究中，收入不平等与健康结果之间的关联更强，这些研究使用1990年后的数据，随访时间更长（>7年），并纳入收入不平等与结果之间的时间滞后。相比之下，对未计量的区域特征的分析表明，收入不平等与健康之间的关联较弱。结论：研究结果表明，收入不平等对健康有适度的不利影响，尽管如果这种关联是真正的因果关系，人口影响可能会更大。研究结果还支持阈值效应假说，该假说假定存在一个收入不平等的阈值，超过该阈值，对健康的不利影响开始出现。鉴于研究之间的异质性，以及在试图控制收入高度不平等地区的不可计量特征的分析中风险估计的衰减，需要谨慎解释这些结果。
Objective To provide quantitative evaluations on the association between income inequality and health. Design Random effects meta-analyses, calculating the overall relative risk for subsequent mortality among prospective cohort studies and the overall odds ratio for poor self rated health among cross sectional studies. Data sources PubMed, the ISI Web of Science, and the National Bureau for Economic Research database. Review methods Peer reviewed papers with multilevel data. Results The meta-analysis included 59 509 857 subjects in nine cohort studies and 1 280 211 subjects in 19 cross sectional studies. The overall cohort relative risk and cross sectional odds ratio (95% confidence intervals) per 0.05 unit increase in Gini coefficient, a measure of income inequality, was 1.08 (1.06 to 1.10) and 1.04 (1.02 to 1.06), respectively. Meta-regressions showed stronger associations between income inequality and the health outcomes among studies with higher Gini (≥0.3), conducted with data after 1990, with longer duration of follow-up (>7 years), and incorporating time lags between income inequality and outcomes. By contrast, analyses accounting for unmeasured regional characteristics showed a weaker association between income inequality and health. Conclusions The results suggest a modest adverse effect of income inequality on health, although the population impact might be larger if the association is truly causal. The results also support the threshold effect hypothesis, which posits the existence of a threshold of income inequality beyond which adverse impacts on health begin to emerge. The findings need to be interpreted with caution given the heterogeneity between studies, as well as the attenuation of the risk estimates in analyses that attempted to control for the unmeasured characteristics of areas with high levels of income inequality.
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影响因子：
5.4
作者：
Kondo, Naoki;Kawachi, Ichiro;Subramanian, S. V.;Takeda, Yasuhisa;Yamagata, Zentaro
通讯作者：
Yamagata, Zentaro
影响因子：
6.3
作者：
Gravelle, H;Sutton, M
通讯作者：
Sutton, M
影响因子：
3.5
作者：
Jones, Andrew M.;Wildman, John
通讯作者：
Wildman, John
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
5
作者：
Idler, EL;Benyamini, Y
通讯作者：
Benyamini, Y