Balabanova Dina C, McKee Martin
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
Scand J Public Health. 2002;30(4):306-12. doi: 10.1080/14034940210164867.
Self-reported health has been widely used in studies of health inequalities in many industrialized countries, but there is still little information on their distribution within populations in countries in Central and Eastern Europe (CEE). There is growing evidence that, since the political transition at the end of the 1980s, income and health inequalities have widened considerably throughout CEE. This paper examined self-perceived health in Bulgaria in relation to financial status (measured by income and self-assessed financial status) after adjustment for other potential explanatory variables.
Data were derived from a national representative survey of the population of Bulgaria aged over 18, in 1997. Respondents were asked "How would you describe your own health status over the past 12 months on the whole?" with answers "good", "rather good", "rather poor", and "poor". Responses were assessed in relation to a variety of measures including income, education, marital status, and self-perceived financial hardship.
As expected, the prevalence of poor/rather poor health increases steeply with age. Those with only primary education are more likely to be in poor/rather poor health than those with secondary or higher education. Self-assessed financial status is a much better predictor of health than is income, with the relationship especially strong among women. There was no association with marital status or urban vs. rural dwelling.
The survey found marked inequalities in self-reported health in Bulgaria. Some of its determinants, such as age and education, are comparable to those seen in the West. Self-reported health is particularly associated with self-perceived financial hardship, a proxy for material deprivation that is sensitive to informal economic exchanges. An accelerated pace of economic and social reforms at the end of the 1990s means that the health divisions in Bulgaria are likely to increase in the short term.
自我报告的健康状况在许多工业化国家的健康不平等研究中已被广泛使用，但关于中东欧国家（CEE）人群中其分布的信息仍然很少。越来越多的证据表明，自20世纪80年代末政治转型以来，中东欧各地的收入和健康不平等现象大幅加剧。本文在对其他潜在解释变量进行调整后，研究了保加利亚自我感知的健康状况与财务状况（以收入和自我评估的财务状况衡量）之间的关系。
数据来自1997年对保加利亚18岁以上人口的全国代表性调查。受访者被问及“总体而言，你如何描述过去12个月自己的健康状况？”，答案有“好”、“较好”、“较差”和“差”。根据包括收入、教育、婚姻状况和自我感知的经济困难等多种指标对回答进行评估。
正如预期的那样，健康状况差/较差的患病率随年龄急剧上升。只有小学教育程度的人比有中学或更高教育程度的人更有可能健康状况差/较差。自我评估的财务状况比收入更能预测健康状况，这种关系在女性中尤为明显。与婚姻状况或城乡居住情况无关。
该调查发现保加利亚自我报告的健康状况存在明显的不平等。其一些决定因素，如年龄和教育程度，与西方的情况相当。自我报告的健康状况尤其与自我感知的经济困难相关，经济困难是物质匮乏的一个指标，对非正规经济交易很敏感。20世纪90年代末经济和社会改革步伐加快意味着保加利亚的健康差距在短期内可能会加大。
