EVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis
EVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis
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循证公共卫生政策和实践 中东欧前共产主义国家和前苏联的社会特征和健康：多层次分析
DOI：
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
M. Marmot
中科院分区：
文献类型：
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作者：
M. Bobák;M. Murphy;R. Rose;M. Marmot
目的：研究在经历了深刻的社会和经济转型的前共产主义国家，健康状况是否与收入不平等和其他社会特征相关，以及这是否代表了健康状况与个人社会经济环境之间的联系。设计：横断面数据的多水平分析。设置：来自中欧和东欧以及前苏联的13个国家。参与者：18岁以上的人口样本（共15，331名受访者）。平均结果测量：自我评价健康状况不佳。结果如下：参与国之间在以下方面存在显著差异：健康不良率（健康不良率最高和最低的国家之间相差两倍以上）、按购买力平价调整的人均国内生产总值（相差三倍以上）、收入不平等的基尼系数（相差两倍）、腐败指数（相差两倍）和杀人率（相差20倍）。在医学上，年龄和性别标准化的自评健康状况不佳的患病率与15岁时的预期寿命密切相关（r = 20.73）。在多层次分析中，社会（国家一级）收入不平等的措施与健康状况不佳无关。在控制了个人的社会经济状况后，腐败和人均国内生产总值与健康状况不佳有关（教育、家庭收入、婚姻状况和家庭物品所有权）;优势比为1.15（95%置信区间1.03 - 1.29）/1件（以10分制）腐败指数上升，人均国内生产总值每增加5000美元，腐败指数上升0.79（95%置信区间为0.68至0.93）。国内生产总值和腐败对家庭收入低于和高于中位数的人的影响几乎相同。结论：繁荣和腐败的社会措施，而不是收入不平等，与健康独立的个人层面的社会经济特征。这些影响在低收入和高收入人群中相似，这一发现表明，这些因素并不完全通过贫困发挥作用。
Objectives: To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Design: Multilevel analysis of cross-sectional data. Setting: 13 Countries from Central and Eastern Europe and the former Soviet Union. Participants: Population samples aged 18+ years (a total of 15 331 respondents). Mean outcome measures: Poor self-rated health. Results: There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the ageand sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = 20.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals’ socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Conclusion: Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual-level socioeconomic characteristics. The finding that these effects were similar in persons with lower and higher income suggests that these factors do not operate exclusively through poverty.
影响因子：
5
作者：
Idler, EL;Benyamini, Y
通讯作者：
Benyamini, Y