Bobak M, Pikhart H, Rose R, Hertzman C, Marmot M
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, UK.
Soc Sci Med. 2000 Nov;51(9):1343-50. doi: 10.1016/s0277-9536(00)00096-4.
This study examined the association between perceived control and several socioeconomic variables and self-rated health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on self-rated health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to self-rated health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics.
本研究调查了七个后共产主义国家（俄罗斯、爱沙尼亚、立陶宛、拉脱维亚、匈牙利、波兰、捷克共和国）中感知控制与若干社会经济变量以及自评健康之间的关联。采用问卷调查访谈的方式收集了过去12个月内的自评健康、教育程度、婚姻状况、基于九个问题的感知控制以及基于食物、衣物和取暖条件的物质匮乏状况的数据。对于每一个人群，有两种物质不平等的生态测量指标：一种是根据调查数据估算的不平等得分，即物质匮乏状况第90百分位数与第10百分位数之间的差距；另一种是来自已发表资料的基尼系数。对5330名年龄在20至60岁之间的男性和女性的数据进行了分析。健康状况较差（比平均水平差）的患病率在捷克人为8%，匈牙利人为19%之间有所不同。大学学历与小学学历相比，年龄性别调整后的优势比为0.36（0.26 - 0.49）；感知控制和物质匮乏每增加1个标准差，优势比分别为0.58（95%置信区间0.48 - 0.69）和1.51（1.40 - 1.63）。不平等程度增加相当于最不平等人群与最平等人群之间差异时的优势比，采用物质不平等得分时为1.49（0.88 - 2.52），采用基尼系数时为1.41（0.91 - 2.20）。在对个体的匮乏状况或感知控制进行调整后，未发现任何一种不平等测量指标有显著影响。结果表明，与西方人群一样，教育和物质匮乏与自评健康密切相关。从统计学角度看，感知控制似乎介导了物质匮乏的一些影响。通过控制个体特征，两种不平等生态测量指标的不显著影响均被消除。
