SOCIAL INEQUALITIES AND HEALTH-STATUS IN WESTERN GERMANY
SOCIAL INEQUALITIES AND HEALTH-STATUS IN WESTERN GERMANY
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DOI：
10.1016/s0033-3506(05)80070-8
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发表时间：
1994-09-01
期刊：
影响因子：
5.2
通讯作者：
SHEA, S
中科院分区：
文献类型：
--
作者：
HELMERT, U;SHEA, S
研究目的：研究德国西部七种自报疾病的社会阶层梯度。设计：对德国西部三个横断面代表性健康调查和德国心血管预防研究六个干预地区的三个健康调查进行汇总分析。参与者：44，363名研究对象，男女，德国国籍，年龄25-69岁，方法和主要结果：采用标准化的自填式调查表进行疾病患病率的调查。 社会阶层的评估采用了一个综合指数，结合教育成就，职业地位和家庭收入。 吸烟和A型行为是基于自我报告。 体格检查测量身高、体重，计算体重指数。 使用多元逻辑回归进行统计分析。 国家调查的答复率为66.0%至71.4%，区域调查的答复率为65.9%至83.8%。 就男女两性而言，在社会较低阶层中，先前心肌梗塞的患病率以及中风、糖尿病和慢性支气管炎的患病率明显较高。 仅在男性中，椎间盘损伤和消化性溃疡的患病率在较低的社会阶层中明显较高。 仅在女性中，高尿酸血症和痛风的梯度相似。 在男女两性中，过敏症和花粉热是在较高社会阶层中流行率较高的唯一疾病。 调整这些趋势吸烟，肥胖和模式A的行为导致只有轻微的变化，在特定疾病的社会阶层gradient.Conclusion的斜率：在德国西部，尽管卫生系统几乎免费为广大民众，强大的社会阶层的不平等存在许多疾病。 这些不平等不能用吸烟、肥胖或A型行为的社会阶层差异来解释。 需要进行更多的研究，以确定健康状况方面这些持续存在的社会不平等现象的根本原因。
Study Objective: To examine social class gradients for seven self-reported diseases in western Germany.Design: A pooled analysis of three cross-sectional representative health surveys in western Germany and three health surveys in the six intervention regions of the German Cardiovascular Prevention Study.Participants: 44,363 study subjects, of both sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991.Measurement and main results: Assessment of disease prevalence was carried out by a standardized self-administered questionnaire. Social class was assessed using a composite index combining educational achievement, occupational status and household income. Cigarette smoking and Pattern A behaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of previous myocardial infarction and the prevalence of stroke, diabetes mellitus and chronic bronchitis was significantly higher in the lower social classes. In males only, the prevalence of intervertebral disc damage and peptic ulcer was significantly higher in the lower social classes. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseases with higher prevalence in the higher social classes. Adjusting these trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class gradients.Conclusion: In western Germany, despite a health system with almost free access for the general population, strong social class inequalities exist for many diseases. These inequalities cannot be explained by social class differences in smoking, obesity or Pattern A behaviour. More research is needed to identify underlying causes for these persistent social inequalities in health status.