Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S.
Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S.
复制标题
DOI：
10.22158/rhs.v5n1p48
复制
发表时间：
2020-01-01
期刊：
影响因子：
--
通讯作者：
Bazargan, Mohsen
中科院分区：
文献类型：
--
作者：
Assari, Shervin;Chalian, Hamid;Bazargan, Mohsen
背景：较高的社会经济地位（SES）指标，如受教育程度和收入，可降低慢性肺部疾病（CLDs）的风险，如慢性阻塞性肺疾病（COPD）、肺气肿、慢性支气管炎和哮喘。与边缘化相关的收益递减（mdr）是指与非西班牙裔白人等社会特权群体相比，高SES对种族和少数民族等边缘化人群的健康效益较小。然而，mdr是否也适用于教育和收入对CLDs的影响尚不清楚。目的：本研究采用具有全国代表性的样本，探讨了美国成年人受教育程度、收入和慢性疾病之间的种族差异。方法：在本研究中，我们分析了2013年和2014年美国成年人全国代表性调查的数据（n = 25,659）。使用烟草与健康人口评估（PATH）第一阶段成人研究。自变量为受教育程度（高中以下=1，高中毕业= 2，大学毕业=3）和收入（生活贫困=1，生活贫困= 0）。因变量是任何慢性阻塞性肺病（即COPD、肺气肿、慢性支气管炎和哮喘）。协变量为年龄、性别、就业和地区。种族和民族是调节因素。采用Logistic回归对数据进行分析。结果：受教育程度较高的个体和收入较高的个体（摆脱贫困）患CLDs的几率较低。种族和民族在统计上与受教育程度和收入有显著的相互作用，这表明黑人和西班牙裔人受高等教育和收入对降低慢性阻塞性肺病几率的保护作用小于非西班牙裔白人。结论：白人的教育和收入比西班牙裔和黑人更能降低慢性阻塞性肺病的风险。这意味着我们应该预期高社会经济地位的西班牙裔和黑人患慢性阻塞性肺病的风险比预期的要高得多。未来的研究应该测试高水平的环境风险因素是否会导致高收入和受过高等教育的黑人和西班牙裔美国人患慢性阻塞性肺病的高风险。决策者不应将健康不平等缩小为社会经济地位差距，因为社会经济地位水平之间的差距持续存在，高社会经济地位的黑人和西班牙裔仍然面临健康问题的风险。
BACKGROUND: Higher socioeconomic status (SES) indicators such as educational attainment and income reduce the risk of chronic lung diseases (CLDs) such as Chronic Obstructive Pulmonary Disease (COPD), emphysema, chronic bronchitis, and asthma. Marginalization-related Diminished Returns (MDRs) refer to smaller health benefits of high SES for marginalized populations such as racial and ethnic minorities compared to the socially privileged groups such as non-Hispanic Whites. It is still unknown, however, if MDRs also apply to the effects of education and income on CLDs.PURPOSE: Using a nationally representative sample, the current study explored racial and ethnic variation in the associations between educational attainment and income and CLDs among American adults.METHODS: In this study, we analyzed data (n = 25,659) from a nationally representative survey of American adults in 2013 and 2014. Wave one of the Population Assessment of Tobacco and Health (PATH)-Adult study was used. The independent variables were educational attainment (less than high school = 1, high school graduate = 2, and college graduate =3) and income (living out of poverty =1, living in poverty = 0). The dependent variable was any CLDs (i.e., COPD, emphysema, chronic bronchitis, and asthma). Age, gender, employment, and region were the covariates. Race and ethnicity were the moderators. Logistic regressions were fitted to analyze the data.RESULTS: Individuals with higher educational attainment and those with higher income (who lived out of poverty) had lower odds of CLDs. Race and ethnicity showed statistically significant interactions with educational attainment and income, suggesting that the protective effects of high education and income on reducing odds of CLDs were smaller for Blacks and Hispanics than for non-Hispanic Whites.CONCLUSIONS: Education and income better reduce the risk of CLDs among Whites than Hispanics and Blacks. That means we should expect disproportionately higher than expected risk of CLDs in Hispanics and Blacks with high SES. Future research should test if high levels of environmental risk factors contribute to the high risk of CLDs in high income and highly educated Black and Hispanic Americans. Policy makers should not reduce health inequalities to SES gaps because disparities sustain across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.