Sociodemographics, self-rated health, and mortality in the US
Sociodemographics, self-rated health, and mortality in the US
复制标题
DOI：
10.1016/s0277-9536(02)00281-2
复制
发表时间：
2003-06-01
影响因子：
5.4
通讯作者：
Fiscella, K
中科院分区：
文献类型：
--
作者：
Franks, P;Gold, MR;Fiscella, K
使用1987年全国医疗支出调查（美国平民的代表性样本）及其5年死亡率的数据，我们检查了基线自我报告健康(来自SF-20子量表（健康感知、身体功能、角色功能和心理健康）和社会人口统计学（年龄、性别、种族/民族、收入和教育）与随后死亡率之间的调整关系。包括21363名21岁及以上的人，对19812人进行了完全随访。随着年龄的增长，身体功能的下降幅度最大，而心理健康则略有增加。除了角色功能外，女性在所有方面的健康状况都较差。收入越高，健康状况越好，而心理健康状况最不明显。更高的教育水平与更好的健康状况有关，尤其是对健康的看法。与白人相比，黑人的健康状况较差，而拉丁美洲人的健康状况较好。较低的自我报告健康状况预示着调整后死亡率的增加。调整基线自评健康后，收入、教育程度与死亡率之间的关系大大减弱，而年龄、性别、种族/民族与死亡率之间的关系则没有减弱。在年轻人、受教育程度较高的人和白人中，自我评估的健康状况与死亡率的关系更为密切。总之，较低的社会经济地位（SES）和黑人与较低的健康状况和较高的死亡率有关；妇女报告的健康状况较差，但死亡率较低；拉丁美洲人的健康状况更好，死亡率更低。社会经济地位对死亡率的影响在很大程度上可以通过其与自我评估健康的关联来解释，而性别和种族/民族对死亡率的影响似乎是通过独立的途径发挥作用的。由于这些不同的社会人口关系，在研究、临床和政策设置中使用自评健康措施时，应谨慎行事。2003爱思唯尔科学有限公司版权所有。
Using data from the 1987 National Medical Expenditure Survey, a representative sample of US civilians, and their 5-year mortality, we examined the adjusted relationships among baseline self-reported health, derived from SF-20 subscales (health perceptions, physical function, role function and mental health) and sociodemographics (age, sex, race/ethnicity, income and education) and subsequent mortality. Included were 21,363 persons aged 21 and over, with complete follow-up on 19,812. Physical function showed the greatest decline with age, whereas mental health increased slightly. Women reported lower health for all scales except role function. Greater income was associated with better health, least marked for mental health. Greater education was associated with better health, most marked for health perceptions. Compared with whites, blacks reported lower health, whereas Latinos reported higher health. Lower self-reported health predicted increased adjusted mortality. After adjustment for baseline self-rated health, the relationships between income and education and mortality were greatly attenuated, whereas the relationships between age, gender, race/ethnicity and mortality were not. Self-rated health exhibited more profound relationships with mortality in younger persons, those with more education, and whites. In conclusion, lower socioeconomic status (SES), and being black are associated with lower reported health status and higher mortality; women report lower health status but exhibit lower mortality; and Latinos report higher health status and exhibit lower mortality. The effects of SES on mortality are largely explained by their associations with self-rated health, whereas, the effects of gender and race/ethnicity on mortality appear to act through independent pathways. Because of these differential sociodemographic relationships caution is urged when using self-rated health measures in research, clinical, and policy settings. (C) 2003 Elsevier Science Ltd. All rights reserved.