The correlation between socioeconomic status and health self-management in the elderly

Purpose:To determine the correlation between socioeconomic status and health selfmanagement in the elderly and to provide a scientific basis for the promotion of healthy ageing.Methods:We recruited 6173 people aged
60 years from three regions in Hebei Province using the multi-stage stratified cluster sampling method.The participants were surveyed using questionnaires.Results:The health self-management behaviours of elderly people differed with the area of residence,education level,and personal monthly income.An ordered probit model showed that behaviours were better in elderly people who lived in urban areas,who were educated to college level or higher,and with higher monthly incomes(p<0.05).Conclusion:Socioeconomic status plays a decisive role in health self-management in the elderly.We suggest appropriate measures for promoting health self-management among the elderly.

Association and potential mediators between socioeconomic status and childhood obesity in China:findings from a national cohort study

Objective:Socioeconomic status(SES)is associated with childhood obesity,but the underlying factors remain unknown.This study aimed to identify mediators that may explain SES disparities in childhood obesity in China.Methods:Nationally representative longitudinal data from the China Education Panel Survey of 11 o019 children(13.03±0.79)collected from 2013-2014 to 2016-2017 academic years.Overweight/obesity was defined using Chinese national body mass index cut-points.Principal component analysis was used to convert the four SES indicators(maternal and paternal education,and occupation)into one comprehensive variable.Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models.Results:The prevalence of overweight/obesity was 12.8%,and was higher in boys than in girls(17.8%vs.7.6%,P<0.001)at baseline.Among boys,relative risk(RR)of obesity was 1.23(95%CI:1.09 to 1.40,P<O.001)for per unit change in SES.There was no significant association between obesity and SES among girls.Mediation analyses showed that among boys,birth weight,being the only child in the family and children's selfperceived weight status mediated 70.0%of the effects of SES on obesity.No mediation effect was detected in girls.Conclusions:Chinese boys are more likely to be overweight or obese than girls.SES may impact childhood obesity through birth weight,being the only child in the family and children's self-perceived body weight status in boys,but not in girls.More attention should be made to address childhood obesity in high SES families among boys.Interventions targeting at these mediators are needed.

Health status and health disparity in China:a demographic and socioeconomic perspective

Using Chinese General Social Survey(CGSS)in 2005,2008 and 2013,this study investigates health determinants and health inequality in China.The ordinal complementary log-log model is used firstly to examine the impact of individual and contextual factors on self-rated health status.The study further checks the health inequality among subgroups divided by health determinants considered in the determinant model.We find that there are significant gender,residential,ethnic,socioeconomic,emotional,regional,and periodic differences.Moreover,the health status of sub-groups defined by factors used in this research is affected by health determinants in different ways which indicates the impact of these health determinants on health is moderated by each other.We conclude that while the health status generally varies with individual factors and social contexts,each group characterized by individual and contextual features has its own unique needs to improve and maintain their health status in China.The public policies aiming to increase Chinese health status and reduce health inequality must pay close attention to these needs while equalizing the availability,accessibility,and affordability of health facilities and health care system.

Socioeconomic Distribution of Health and Health Care Utilization in a New Town in Hong Kong, China

Objectives To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China. Methods Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between socioeconomic indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. Results Significant positive associations were noted between low household income and diabetes mellitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. Conclusion This study did not demonstrate a unidirectional socioeconomic gradient in healt

Diminished Health Returns of Own and Parental Education for Immigrants in the United States

Background:Educational attainment is a strong social determinant of health.Marginalization-related Diminished Returns(MDRs),however,refer to smaller health effects of socioeconomic status,particularly educational attainment for marginalized groups compared to mainstream populations.While multiple studies have documented MDRs of educational attainment for racial,ethnic,and sexual minorities,there are no previous studies on MDRs of education among immigrants.Aims:To understand if the MDRs phenomenon also applies to immigrants,we compared immigrant and non-immigrant American adults for the effects of their own and parental educational attainment on subjective health.Methods:This study used a cross-sectional design and borrowed data from the General Social Survey(1972-2018).GSS is a series of nationally representative surveys in the U.S.Our analytical sample included 38,399 adults who were either non-immigrants(n=34903;90.9%)or immigrants(n=3496;9.1%).The main independent variables were own and parental educational attainment measured as four-level categorical variables.The dependent variable(DV)was poor subjective health,measured using a single item.Age,sex,marital status,and year of the survey were the covariates.Immigration status was the moderator.Results:Overall,individuals with higher educational attainment of own and parents reported better subjective health.We,however,found significant interactions between immigration status and both own and parental educational attainment on subjective health,which was suggestive of weaker protective effects of own and parental educational attainment against poor subjective health in immigrants than non-immigrant individuals.Conclusions:In the United States,immigrant adults experience poor subjective health disproportionate to their own and their parents educational attainment.That means we may observe worse than expected health of immigrants across all educational levels and social classes.Public policies should go beyond equal access to education by empowering marginalized people to leverage their education and secure better outcomes.

Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation

Over the last 2 decades (1988-2007), poverty in Jamaica has fallen by 67.5%, and this is within the context of a 194.7% increase in inflation for 2007 over 2006. It does not abate there, as Jamaicans are reporting more health conditions in a 4-week period (15.5% in 2007) and at the same time this corresponds to a decline in the percentage of people seeking medical care. Older people’s health status is of increasing concern, given the high rates of prostate cancer, genitourinary disorders, hypertension, diabetes mellitus and the presence of risk factors such as smoking. Yet, there is a dearth of studies on the health status of older people in the two poor quintiles. This study examined 1) the health status of those elderly Jamaicans who were in the two poor quintiles and 2) factors that are associated with their health status. A sample of 1,149 elderly respondents, with an average age of 72.6 years (SD = 8.7 years) were extracted from a total survey of 25,018 Jamaicans. The initial survey sample was selected from a stratified probability sampling frame of Jamaicans. An administered questionnaire was used to collect the data. Descriptive statistics were used to examine background information on the sample, and stepwise logistic regression was used to ascertain the factors which are associated with health status. The health status of older poor people was influenced by 6 factors, and those factors accounted for 26.6% of the variability in health status: Health insurance coverage (OR = 13.90;95% CI: 7.98-24.19), age of respondents (OR = 7.98;95% CI: 1.02-1.06), and secondary level education (OR=1.82;95% CI: 1.35-2.45). Males are less likely to report good health status than females (OR = 0.56;95% CI: 0.42-0.75). Older people in Jamaica do not purchase health insurance coverage as a preventative measure but as a curative measure. Health insurance coverage in this study does not indicate good health but is a proxy of poor health status. The demand of the health services in Jamaica in the future must be geared towards a particular age cohort and certain health conditions, and not only to the general population, as the social determinants which give rise to inequities are not the same, even among the same age cohort.

Population health and sociodemographic variables as predictors of access to cardiac medicine and surgery in Haiti

Background In Haiti,cardiovascular disease is a leading cause of morbidity and mortality,with congenital and rheumatic heart disease comprising a large portion of disease burden.However,domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood.We analyzed population-level sociodemographic variables to predict cardiac care outcomes across the 10 Haitian administrative departments.Methods This cross-sectional study combined data from a 2016-17 Haitian national survey with aggregate outcomes from the Haiti Cardiac Alliance(HCA)database(n=1817 patients).Using univariate and multivariable regression analyses,the proportion of HCA patients belonging to each of three clinical categories(active treatment,lost to follow-up,deceased preoperatively)was modeled in relation to six population-level variables selected from national survey data at the level of the administrative department.Results In univariate analysis,higher department rates of childhood growth retardation were associated with a lower proportion of patients in active care(OR=0.979[0.969,0.989],p=0.002)and a higher proportion of patients lost to follow-up(OR=1.016[1.006,1.026],p=0.009).In multivariable analysis,the proportion of department patients in active care was inversely associated with qualified prenatal care(OR=0.980[0.971,0.989],p=0.005),and child growth retardation(OR=0.977[0.972,0.983]),p=0.00019).Similar multivariable results were obtained for department rates of loss to follow-up(child growth retardation:OR=1.018[1.011,1.025],p=0.002;time to nearest healthcare facility in an emergency:OR=1.004[1.000,1.008,p=0.065)and for preoperative mortality(prenatal care:OR=0.989[0.981,0.997],p=0.037;economic index:OR=0.996[0.995,0.998],p=0.007;time to nearest healthcare facility in an emergency:OR=0.992[0.988,0.996],p=0.0046).Conclusions Population-level survey data on multiple variables predicted domestic disparities in HCA clinical outcomes by region.These findings may help to identify underserved areas in Haiti,where increased cardiac care resources are required to improve health equity.This approach to analyzing clinical outcomes through the lens of population-level survey data may inform future health policies and interventions designed to increase cardiac care access in Haiti and other low-income countries.

社会经济地位对居民健康公平的影响

社会经济地位指个人或群体在阶级社会中的位置。社会经济地位是职业、教育、收入、财富以及居住地区等指标的综合反映。社会学家常用社会经济地位作为预测人们行为的一种手段与方式。据对社会经济地位与居民健康状况有关的研究发现收入差距与健康密切相关;社会经济地位与健康之间有一个梯度关系,而且这并不是只发生在贫困层面;医疗保健服务对健康差距产生的作用比较小;社会经济因素通过多种渠道影响居民的健康状况。

健康的贫富差距及其内在机制

健康的贫富差距是指不同社会经济地位的群体在各种健康指标上的系统差异。在过去30余年间,国外研究揭示了社会经济地位与各种健康指标的负向关系,并从环境特征和个人特征两个层面对健康的贫富差距做出了解释。以实证证据为基础,研究者提出了社会文化自我模型、储备能力模型和生物-心理-社会整合模型等理论模型,尝试从综合的视角理解健康的贫富差距。未来研究应该从多学科跨领域的视角,使用多样化的研究方法和统计技术深化对健康的贫富差距内在机制的理解,充分考虑社会文化背景的影响和个体差异的存在,为促进我国的健康公平实践工作提供切实有效的理论指导。

从毕生发展的视角看健康的贫富差距

健康的贫富差距是所有个体从出生到死亡都需要面对的现实,也是全球所有国家都存在的社会问题。目前已经有相当的理论和实证研究尝试从毕生发展的视角理解健康的贫富差距。在毕生发展研究中,健康的贫富差距有其独特的概念和测量方式。该领域重要的理论包括累积优(劣)势假设、累积不公平模型和社会阶层文化周期模型。研究者就儿童期、青少年期、成年期和老年期的健康贫富差距开展了大量的实证研究。未来毕生发展研究和实践的可能方向包括早年和当前社会经济地位的交互作用、社会经济地位的稳定特征和情境效应、跨领域实践干预等。毕生发展视角的健康贫富差距研究有助于理解健康贫富差距的发展根源和形成过程,是促进国民健康和开展健康公平实践工作的理论基础。

中国就业人群慢性病的社会决定因素

目的:研究中国就业人群慢性病的社会决定因素。方法:从中国家庭动态跟踪调查(Chinese FamilyPanel Studies,CFPS)2010年截面调查资料中提取18～60岁的就业人群,采用Logistic回归模型,分析不同自评社会地位、受教育程度、收入、工作机构和机构属性、管理岗位人群慢性病患病风险的差异。结果:主观社会地位很高或较高者、受教育程度很低及较高者、低收入群体患慢性病的概率较高。从工作性质上看,务农或自己经营的群体比受雇于单位组织的群体患慢性病概率要高;从事管理工作的群体患慢性病的概率也较高。结论:收入、受教育程度、工作方式和工作内容是中国就业群体慢性病的社会决定因素,需要针对这些社会决定因素制定改善健康公平的政策。

城镇化、社会经济地位与居民健康差距

利用1991—2015年“中国健康与营养调查”数据,实证考察城镇化、社会经济地位与居民健康差距之间的关系。研究发现:(1)城镇化影响居民健康。城镇化会显著增加居民的四周患病率,与慢性病患病率和患病数量存在先降后增的关系。(2)城镇化扩大了不同社会经济地位居民之间的健康差距,城镇化对社会经济地位较低居民健康的负面影响更大。(3)机制分析表明,城镇化主要通过生活方式改变、心理压力增大以及肥胖等渠道影响居民的健康状况。因此,在推进新型城镇化和实施“健康中国”战略的背景下,应关注城镇化所带来的健康分配效应,警惕城镇化进程中可能出现的“健康陷阱”。

Health-related quality of life and its correlates among rectal cancer survivors, Northwest of Iran

Aim:The objective of this study was to examine the health-related quality of life(HRQOL),and its correlates among rectal cancer survivors.Methods:This cross-sectional study was conducted in the northwest of Iran.Rectal cancer survivors were selected from teaching hospitals.HRQOL was estimated using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30.Information about socio-demographic,lifestyle and clinical features of disease was obtained by trained interviewers.Results:A total of 96 patients were included in this study with mean age of 57.31±14.15 years,54%were male and 59%over 55 years of age.Women performed poorer than men in many dimensions of HRQOL(P<0.05).Total score of symptoms was higher in those who had a higher stage of the disease.Participants with insufficient physical activity had a lower score in physical and role dimensions and a higher score of pain and fatigue(P<0.05).In multiple regression models,treatment,stage of disease,and physical activity were important predictive factors of HRQOL.Conclusion:Some clinico-epidemiological factors were associated with a reduced score of HRQOL and its dimensions in this study.Overall,better performance in the presence of a modifiable factor;physical activity,is an opportunity for interventional strategies to improve the HRQOL.

Factors associated with use of gastric cancer screening services in Korea

AIM: To identify the factors associated with participation in gastric cancer screening programs. METHODS: Using data from the Korea National Health and Nutrition Examination Survey 2005 (KNHANES Ⅲ), a nationwide health-related surveyin Korea, a cross-sectional study was performed to investigate the multiple factors associated with gastric cancer screening attendance among persons aged at least 40 years. The study population included 4593 individuals who completed a gastric cancer screening questionnaire and had no previous cancer history. Four groups ofindividual-level or environmental level covariates were considered as potential associated factors.RESULTS: Using KNHANES Ⅲdata, an estimated31.71% of Korean individuals aged at least 40 years adhered to gastric cancer screening recommendations. Subjects who graduated from elementary school[adjusted odds ratio (aOR), 1.66; 95% CI: 1.21-2.26], middle/high school (aOR, 1.38; 95% CI: 1.01-1.89), and university or higher (aOR, 1.64; 95% CI: 1.13-2.37) were more likely to undergo gastric cancer screening than those who received no formal education at all. The population with the highest income tertile had more attendance at gastric screening compared to those with the lowest income tertile (aOR, 1.36; 95% CI: 1.06-1.73). Gastric screening was also negatively associated with excessive alcohol consumption (aOR, 0.71; 95% CI: 0.53-0.96). A positive attitude to preventive medical evaluation was significantly associated with better participation in gastric cancer screening programs (aOR, 5.26; 95% CI: 4.35-6.35). CONCLUSION: Targeted interventions for vulnerable populations and public campaigns about preventive medical evaluation are needed to increase gastric cancer screening participation and reduce gastric cancer mortality.

社会压力与健康不平等——基于CLHLS数据的实证分析

健康不平等长期以来受到学界和社会各界的广泛关注。在控制遗传基因等与生俱来的个体异质性前提下,研究和发现外部社会环境因素对个体健康差异的影响,对于减小健康不平等、维护健康公平具有重要的研究意义。基于中国长寿健康影响因素跟踪调查(CLHLS)的研究结果表明,社会压力与社会经济地位之间存在显著的负向相关性,较高的社会压力所对应的是较低的社会经济地位,反之亦然。并且,社会压力对于健康的负面影响程度在不同社会经济地位群体中也存在差异,社会压力对于社会经济地位较低群体的健康的负面影响更大。社会压力对于解释健康不平等的作用应引起研究者的重视。