Social class, marginality and self-assessed health: a cross-sectional analysis of the health gradient in Mexico
Social class, marginality and self-assessed health: a cross-sectional analysis of the health gradient in Mexico
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DOI：
10.1186/1475-9276-8-3
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发表时间：
2009-02-23
影响因子：
4.8
通讯作者：
Martinez Valle, Adolfo
中科院分区：
文献类型：
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作者：
Martinez Valle, Adolfo
背景：研究社会不平等与健康之间的关系并不新鲜。然而，在拉丁美洲文献中很少有这种联系的经验证据，更不用说墨西哥学者了。它的研究，包括在墨西哥进行的一个，主要是遵循一个理论的方法，并没有能够提供强有力的实证证据，他们的重要理论和概念的贡献，主要是因为可靠，完整和有效的数据是unavailable.Methods：实证研究的梯度效应，社会阶层对自测健康在墨西哥，二次横截面混合水平分析。使用第二次全国健康调查（ENSA II）的个人数据，根据ENSA II提供的职业和教育指标，按照分层方法确定了社会阶层类别。划分了两类，一类是城镇劳动力，一类是农村劳动力。两个指标的感知健康状况被用作健康结果：自我评估的健康和报告的发病率。此外，边缘化指数，相对剥夺的指标被用来检查其在国家和地区一级的背景效果。结果：横断面分析显示，社会阶层对良好健康评估存在梯度效应。相对于低城市阶层，属于高城市阶层的个体对健康的良好感知的比值比（OR）为2.9（95%置信区间：2.1-3.9）。中高等级的OR为2.8（95%置信区间：2.4-3.4），而中低等级的OR为1.8（95%置信区间：1.6-2.1）。然而，对于农村劳动力，OR为1.5的高级别之间只有显着谁认为他们的健康状况良好，相对于低级别（95%置信区间：1.02-2.2）。在总体水平上，结果还显示，生活在贫困地区的个人比生活在相对不那么贫困的地区的个人更不可能报告他们的健康状况良好，OR = 0.6（95%置信区间：0.4-0.7）。总的来说，这项研究的结果提供了经验证据，表明社会不平等通过不同的接触和不平等的分配对健康产生负面影响。社会阶层越低，健康的感知越差。结果还表明，生活在更贫困的地区对健康有进一步的负面影响。从政策的角度来看，社会阶层的梯度效应表明，非针对性政策的设计应既解决个人层面的物质条件，也解决更高层面的总体贫困生活条件，以改善整个社会阶层的健康状况。
Background: Examining the association between social inequality and health is not new. However, there is little empirical evidence of this association in the Latin American literature, much less from the Mexican scholars. Its research, including the one conducted in Mexico, has mostly followed a theoretical approach and has not been able to provide strong empirical evidence of their important theoretical and conceptual contributions, mainly because reliable, complete and valid data are unavailable.Methods: To empirically examine the gradient effect of social class on self-rated health in Mexico, a secondary cross-sectional mixed-level analysis was designed. Using individual level data from the Second National Health Survey (ENSA II), social class categories were specified following a stratification approach according to the occupation and education indicators available from ENSA II. Two types of categories were made, one for t urban and one for the rural labor force. Two indicators of perceived health status were used as health outcomes: self-assessed health and reported morbidity. Furthermore, the marginality index, an indicator of relative deprivation was used to examine its contextual effect at the state and regional level. The analysis was conducted using logistic multivariate models.Results: The cross-sectional analysis showed a gradient effect of social class for good assessed-health. Relative to the low urban class, the odds ratio (OR) for a good perception of health for individuals belonging to the high urban class was 2.9 (95% confidence interval: 2.1-3.9). The OR for the middle high class was 2.8 (95% confidence interval: 2.4-3.4), while the OR for the middle low class was 1.8 (95% confidence interval: 1.6-2.1). However, for the rural labour force an OR of 1.5 was only significant between the high class who considered their health as good relative to the low class (95% confidence interval: 1.02-2.2). At the aggregate level, the results also showed individuals living in deprived regions were less likely to report their health as good than individuals living in relatively less deprived ones, OR = 0.6 (95% confidence interval: 0.4-0.7).Conclusion: Overall, the findings of this study provided empirical evidence that social inequality negatively influences health through a differential exposure and an unequal distribution of resources across the class spectrum: the lower the social class, the poorer the perception of health. The results also showed that living in more deprived regions had a further negative effect on health. From a policy perspective, the gradient effects of social class suggest that non-targeted policies should be designed to address both material conditions at the individual level as well as deprived living conditions at higher levels of aggregation to improve health across the social spectrum.