An additional dimension to health inequalities: disease severity and socioeconomic position
An additional dimension to health inequalities: disease severity and socioeconomic position
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DOI：
10.1136/jech.53.10.603
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发表时间：
1999-10-01
影响因子：
6.3
通讯作者：
Smith, GD
中科院分区：
文献类型：
--
作者：
Eachus, J;Chan, P;Smith, GD
目的 - 使用一系列个人和生态社会经济指标，调查髋部疼痛的严重程度和残疾的严重程度以及一系列社会经济地位指标之间的关联。设计采访者管理和自行填写的关于疼痛和残疾症状、一般健康和社会经济指标的调查问卷，由在横断面、邮寄、筛查问卷中报告髋部疼痛的人完成。设置 - 来自英格兰西南部内城、郊区和农村地区的 40 个一般实践。参与者 - 954 名在一项研究中报告过髋部疼痛的研究参与者采用年龄\性别分层随机概率样本对 26 046 名 35 岁及以上人群进行邮寄问卷调查。数据-社会经济地位的个人指标：基于职业的社会阶层、最大受教育程度、汽车拥有量、家庭总收入、体力或非体力职业以及独居。地区级社会经济地位衡量标准：普查区一级物质匮乏的汤森分数；基于居住邮政编码的城市或农村位置。髋部疾病的严重程度，通过新西兰主要关节置换评分的疼痛、残疾和独立性部分来衡量。使用一般实践病例说明和一般健康状况总结措施验证了自我报告的合并症。主要结果 - 疾病严重程度的增加与年龄的增长和各种一般健康措施（包括合并症）密切相关。这些数据为髋部疾病严重程度的增加与社会经济地位的下降之间的系统关联提供了相当多的证据。与疾病严重程度增加系统相关的社会经济地位指标（按年龄和性别标准化）包括受教育程度（相对不平等指数 1.95（95% 置信区间 1.29 至 2.62）和收入（相对不平等指数 4.03（95% 置信区间 3.43 至 4.64）。有汽车的人（平均疾病严重程度 15.5）的髋关节疾病严重程度显着低于没有汽车的人（平均疾病严重程度 15.5）。 17.5，第
Objective-To investigate the association between the severity of hip pain and disability, and a number of measures of socioeconomic position, using a range of individual and ecological socioeconomic indicators.Design-Interviewer administered and self completed questionnaires on symptoms of pain and disability, general health and socioeconomic indicators, completed by people reporting hip pain in a cross sectional, postal, screening questionnaire.Setting-40 general practices from inner city, suburban and rural areas of south west England.Participants-954 study participants who had reported hip pain in a postal questionnaire survey of 26 046 people aged 35 and over, selected using an age\sex stratified random probability sample.Data-Individual indicators of socioeconomic position: social class based on occupation, maximum educational attainment, car ownership, gross household income, manual or non-manual occupation and living alone. Area level measures of socioeconomic position: Townsend scores for material deprivation at enumeration district level; urban or rural location based on the postcode of residence. Severity of hip disease, measured by the pain, disability and independence components of the New Zealand score for major joint replacement. Self reported comorbidity validated using general practice case notes and summary measures of general health.Main results-Increasing disease severity was strongly associated with increasing age and a variety of measures of general health, including comorbidity. The data provide considerable evidence for the systematic association of increased severity of hip disease with decreasing socioeconomic position. Measures of socioeconomic position that were systematically associated with increasing disease severity, standardised for age and sex, included educational attainment (relative index of inequality 1.95 (95% confidence intervals 1.29 to 2.62) and income (relative index of inequality 4.03 (95% confidence intervals 3.43 to 4.64). Those with access to a car (mean disease severity 15.5) had statistically significant lower severity of hip disease than those without (mean 17.5, p