Are older adults living in more equal counties healthier than older adults living in more unequal counties? A propensity score matching approach.
Are older adults living in more equal counties healthier than older adults living in more unequal counties? A propensity score matching approach.
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DOI：
10.1016/j.socscimed.2015.07.020
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Heisler M
中科院分区：
文献类型：
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作者：
Choi H;Burgard S;Elo IT;Heisler M
我们通过以下方式评估了收入不平等对健康的潜在背景影响：1）比较具有相似社会经济地位（SES）但居住在收入不平等程度不同的县的个人； 2) 研究县级收入不平等对健康的潜在影响是否因社会经济地位群体而异。我们使用了健康与退休研究，这是一项针对 50 岁以上美国人的全国代表性研究。通过倾向得分匹配，我们选择了生活在高收入不平等县和低收入不平等县的社会经济地位相当的个人。我们使用逻辑回归（n=34,994）检查了两组之间自评整体健康结果和其他特定身体/心理健康结果的差异，并根据该地区的居住时间施加不同的样本限制。然后，我们使用具有交互作用的逻辑回归来评估由财富、收入和教育定义的不同 SES 群体的参与者之间的健康结果是否存在差异，如果有的话，如何差异。在对未匹配的完整样本的双变量分析中，生活在高收入不平等县的成年人的大多数健康指标的健康结果较差。倾向评分匹配后，与低收入不平等县的成年人相比，高收入不平等县的成年人自评健康状况较差（AOR=1.12；95% CI 1.04-1.19），并且更有可能报告诊断出的精神问题（AOR=1.08；95% CI 0.99-1.19）。这些关联与该地区的长期居民更加紧密。生活在高收入不平等县的不利健康后果非常严重，特别是对于收入/财富分配第 30 个或更高百分位数的个人以及没有受过大学教育的人来说。总之，在使用更精确的匹配方法来比较具有相似特征的个体并通过排除最近到达的县居民来解决测量误差后，生活在高收入不平等县的成年人的整体身心健康状况比生活在低收入不平等县的成年人更差。
We assessed the potential contextual effect of income inequality on health by: 1) comparing individuals with similar socioeconomic status (SES) but who reside in counties with different levels of income inequality; and 2) examining whether the potential effect of county-level income inequality on health varies across SES groups. We used the Health and Retirement Study, a nationally representative study of Americans over the age of 50. Using propensity score matching, we selected SES-comparable individuals living in high-income inequality counties and in low-income inequality counties. We examined differences in self-rated overall health outcomes and in other specific physical/mental health outcomes between the two groups using logistic regression (n=34,994) and imposing different sample restrictions based on residential duration in the area. We then used logistic regression with interactions to assess whether, and if so how, health outcomes differed among participants of different SES groups defined by wealth, income, and education. In bivariate analyses of the unmatched full sample, adults living in high-income inequality counties have worse health outcomes for most health measures. After propensity score matching, adults in high-income inequality counties had worse self-rated health status (AOR=1.12; 95% CI 1.04–1.19) and were more likely to report diagnosed psychiatric problems (AOR=1.08; 95% CI 0.99–1.19) than their matched counterparts in low-income inequality counties. These associations were stronger with longer-term residents in the area. Adverse health outcomes associated with living in high-income inequality counties were significant particularly for individuals in the 30th or greater percentiles of income/wealth distribution and those without a college education. In summary, after using more precise matching methods to compare individuals with similar characteristics and addressing measurement error by excluding more recently arrived county residents, adults living in high-income inequality counties had worse reported overall physical and mental health than adults living in low-income inequality counties.