Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey
Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey
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DOI：
10.1016/s0277-9536(98)00095-1
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发表时间：
1998-07-01
影响因子：
5.4
通讯作者：
Marmot, M
中科院分区：
文献类型：
--
作者：
Bobak, M;Pikhart, H;Marmot, M
俄罗斯是工业化国家中预期寿命最低的国家，但对俄罗斯人口的其他健康结果和健康决定因素知之甚少。在这里，我们报告了一项横断面研究，在俄罗斯人口的社会和心理社会决定因素的两个自我报告的健康指标：自我评价的健康（显示预测死亡率的前瞻性研究）和身体功能（验证对更客观的健康措施）的国家样本。对俄罗斯18岁及以上人口的多阶段抽样进行了采访（n = 1599，应答率66%）。调查问卷包括政治态度、社会和经济情况、心理社会因素、吸烟、饮酒、自测健康和身体功能（来自SF 36工具）。分别从6个和3个问题中计算了对生活和健康的感知控制得分。通过逻辑回归分析数据，得出两个二分结果：自评健康状况不佳（低于平均水平）和身体功能低下（低于最大值的60%）。总体而言，25%的受试者认为他们的健康状况比平均水平差;这比西方国家要高得多。对生活的感知控制与这两种结局密切相关;门自测健康和低身体功能的年龄和性别调整OR为1个标准差增加0.60（95%CI 0.52-0.69）。根据一系列其他因素进行调整后，这些估计值仅略有下降。控制一个人的健康和这两个结果之间的关联也是显着的，但在多变量模型中较弱和衰减。物质匮乏也与这两种结果密切相关。受教育程度与自我评价的健康状况呈负相关，未婚男性更经常报告身体机能不佳。受试者;不赞成经济变化的人健康状况较差，但通过调整社会经济因素和控制措施，这种关联被消除。受试者谁不能依赖于非正式的社会结构时，在问题报告健康状况较差，这种影响在很大程度上持续在多变量分析。这些结果与俄罗斯健康状况不佳与社会结构功能障碍、社会经济剥夺和缺乏感知控制有关的假设一致。非正式的社交网络对维持大众福利至关重要，但这种网络的缺失似乎对自我评价的健康状况产生了负面影响。抑郁症和低感知控制可能是广泛的社会环境和健康之间的重要调解人在人口转型，可以提供一个有用的框架，许多生物和行为因素。需要前瞻性研究来解决时间性和报告偏倚的问题，这是解释这些发现的主要问题。(C)1998爱思唯尔科技有限公司版权所有。
Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of health in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychosocial determinants of two self-reported health indicators: self rated health (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A multi-stage sample of the Russian population aged 18 years and more was interviewed (n = 1599, response rate 66%). The questionnaire included political attitudes, social and economic circumstances, psychosocial factors, smoking, alcohol consumption, self-rated health and physical functioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, respectively. Data were analysed in logistic regression for two dichotomised outcomes: poor self-rated health (worse than average) and low physical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly related to both outcomes; age- and sex-adjusted OR for 1 standard deviation increase in control were 0.60 (95% CI 0.52-0.69) for Door self-rated health and 0.67 (0.57-0.81) for low physical functioning. Adjustment ibr a battery of other factors reduced these estimates only slightly. Associations between control over one's health and both outcomes were also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Education was inversely related to self-rated health, and unmarried men reported poor physical functioning substantially more often. Subjects; not approving the economic changes reported poorer health but this association was removed by adjustment for socioeconomic factors and control. Subjects who could not rely on informal social structures when in problems reported worse health; this effect largely persisted in multivariate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social structures, socioeconomic deprivation, and lack of perceived control. The absence of informal social networks, vital for maintaining general welfare, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can provide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings. (C) 1998 Elsevier Science Ltd. All rights reserved.