Subramanian Venkata, Delgado Iris, Jadue Liliana, Kawachi Ichiro, Vega Jeanette
Pontificia Universidad Católica de Chile.
Rev Med Chil. 2003 Mar;131(3):321-30.
The correlation between income inequality and life expectancy was demonstrated 10 years ago, but later, several studies suggested that the negative impact of a low economic income on the health status was disappearing.
To assess the independent effects of community income inequality on self rated health in Chile.
Multilevel analysis of the 2000 National Socio Economic Characterization Survey (CASEN) data from Chile. Individual level information included self rated health, age, sex, ethnicity, marital status, education, income, type of health insurance and residential setting (urban/rural). Community level variables included the Gini coefficient and median income. The main outcome measure was dichotomized self rated health (0 if excellent, very good or good; 1 if fair or poor).
101,374 individuals (at level 1) aged 18 and above, nested within 285 communities (at level 2) and 13 regions (at level 3) were studied. Controlling for a range of individual level predictors, a significant gradient was observed between income and poor self rated health, with very poor most likely to report poor health (10.5%) followed by poor (9.5%) low (9%) middle (7%), high (6%) and very high (4.5%) income earners. Controlling for individual and community effects of income, a significant non linear effect of community income inequality was observed, with the most unequal communities being associated with approximately 5% higher likelihood of reporting poor health compared to the most equal communities.
Individual income does not explain any of the between community differences and neither does it wash the significant effects of income inequality on poor self rated health. The contextual effect of inequality is almost as large as the differential observed in poor health comparing the very poor to the very rich individual income categories.
收入不平等与预期寿命之间的关联在10年前就已得到证实，但后来有几项研究表明，低经济收入对健康状况的负面影响正在消失。
评估智利社区收入不平等对自我评定健康状况的独立影响。
对来自智利的2000年全国社会经济特征调查（CASEN）数据进行多层次分析。个体层面的信息包括自我评定健康状况、年龄、性别、种族、婚姻状况、教育程度、收入、医疗保险类型和居住环境（城市/农村）。社区层面的变量包括基尼系数和收入中位数。主要结局指标是二分法的自我评定健康状况（如果为优秀、非常好或良好则为0；如果为一般或较差则为1）。
研究了101374名18岁及以上的个体（一级层面），这些个体嵌套在285个社区（二级层面）和13个地区（三级层面）中。在控制一系列个体层面的预测因素后，观察到收入与自我评定健康状况差之间存在显著梯度，收入极低者最有可能报告健康状况差（10.5%），其次是收入低者（9.5%）、收入中等者（9%）、收入高者（7%）、收入很高者（6%）和收入极低者（4.5%）。在控制了收入的个体和社区效应后，观察到社区收入不平等存在显著的非线性效应，与最平等的社区相比，最不平等的社区报告健康状况差的可能性高出约5%。
个体收入无法解释社区之间的任何差异，也不能消除收入不平等对自我评定健康状况差的显著影响。不平等的背景效应几乎与在健康状况差方面观察到的将收入极低者与收入极高者个体收入类别进行比较时的差异一样大。
