Race and health profiles in the United States: an examination of the social gradient through the 2009 CHIS adult survey
Race and health profiles in the United States: an examination of the social gradient through the 2009 CHIS adult survey
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DOI：
10.1016/j.puhe.2014.10.003
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发表时间：
2014-12-01
期刊：
影响因子：
5.2
通讯作者：
Chou, W. -Y.
中科院分区：
文献类型：
--
作者：
Nguyen, A. B.;Moser, R.;Chou, W. -Y.
目的：研究社会梯度对多种健康结果和行为的作用。据预测，以教育程度和家庭收入衡量的较高水平的社会经济地位将与积极的健康行为（即吸烟、饮酒、体力活动和饮食）和健康状况（即由于慢性病、血压、肥胖、糖尿病、体重指数和感知健康状况而限制体力活动）相关。该研究还考察了不同种族/族裔群体（即非西班牙裔白人、黑人、亚洲人、西班牙裔和美洲印第安人）之间社会梯度对健康的差异影响。 研究设计：横断面研究。 方法：数据来自 2009 年加州成人健康访谈调查 (CHIS)。采用加权多变量线性和逻辑回归模型来检查 SES 与健康状况和健康行为之间的趋势。检查了所有线性和逻辑模型的多项式趋势，以测试社会梯度对按种族/族裔分层的健康行为和结果的可能影响（线性、二次和三次）。结果：研究结果表明，总体而言，与其他种族/族裔群体相比，白人拥有更有利的健康状况，但亚洲人可能与白人一样健康或更健康。预测边缘表明，在所有其他种族/族裔群体中，社会阶层上两个阶层的亚洲人表现出最健康的健康状况。此外，社会梯度与不同种族/族裔群体的健康结果存在不同的相关性。虽然白人的社会梯度最为一致，但教育对黑人和美洲印第安人的健康没有同样的保护作用。此外，与其他少数群体相比，西班牙裔和亚洲人更有可能表现出社会梯度的曲线趋势：从低社会经济地位到中水平社会经济地位的最初增长与更差的健康结果和行为相关；然而，从中社会经济地位到高社会经济地位的持续增长看到了健康结果和行为的回归。结论：该研究通过说明全国代表性样本中不同种族/族裔人口的社会梯度的独特模式和趋势，为文献做出了贡献。未来的研究应进一步探索时间趋势，以追踪社会梯度对不同种族和民族人口的影响以及国民收入不平等指数。由爱思唯尔有限公司代表英国皇家公共卫生学会出版。
Objective: To examine the role of the social gradient on multiple health outcomes and behaviors. It was predicted that higher levels of SES, measured by educational attainment and family income, would be associated with positive health behaviors (i.e., smoking, drinking, physical activity, and diet) and health status (i.e., limited physical activity due to chronic condition, blood pressure, obesity, diabetes, BMI, and perceived health condition). The study also examined the differential effects of the social gradient in health among different racial/ethnic groups (i.e., non-Hispanic Whites, Blacks, Asian, Hispanics, and American Indians).Study design: Cross-sectional study.Methods: The data were from the adult 2009 California Health Interview Survey (CHIS). Weighted multivariable linear and logistic regression models were conducted to examine trends found between SES and health conditions and health behaviors. Polynomial trends were examined for all linear and logistic models to test for the possible effects (linear, quadratic, and cubic) of the social gradient on health behaviors and outcomes stratified by race/ethnicity.Results: Findings indicated that, in general, Whites had more favorable health profiles in comparison to other racial/ethnic groups with the exception of Asians who were likely to be as healthy as or healthier than Whites. Predicted marginals indicated that Asians in the upper two strata of social class display the healthiest outcomes of health status among all other racial/ethnic groups. Also, the social gradient was differentially associated with health outcomes across race/ethnicity groups. While the social gradient was most consistently observed for Whites, education did not have the same protective effect on health among Blacks and American Indians. Also, compared to other minority groups, Hispanics and Asians were more likely to display curvilinear trends of the social gradient: an initial increase from low SES to mid-level SES was associated with worse health outcomes and behaviors; however, continued increase from mid-SES to high SES saw returns to healthy outcomes and behaviors.Conclusion: The study contributes to the literature by illustrating unique patterns and trends of the social gradient across various racial/ethnic populations in a nationally representative sample. Future studies should further explore temporal trends to track the impact of the social gradient for different racial and ethnic populations in tandem with indices of national income inequalities. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.