van Doorslaer Eddy, Gerdtham Ulf G
Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, Netherlands.
Soc Sci Med. 2003 Nov;57(9):1621-9. doi: 10.1016/s0277-9536(02)00559-2.
This paper empirically addresses two questions using a large, individual-level Swedish data set which links mortality data to health survey data. The first question is whether there is an effect of an individual's self-assessed health (SAH) on his subsequent survival probability and if this effect differs by socioeconomic factors. Our results indicate that the effect of SAH on mortality risk declines with age-probably because of adjustment towards 'milder' overall health evaluations at higher ages-but does not seem to differ by indicators of socioeconomic status (SES) like income or education. This finding suggests that there is no systematic adjustment of SAH by SES and therefore that any measured income-related inequality in SAH is unlikely to be biased by reporting error. The second question is: how much of the income-related inequality in mortality can be explained by income-related inequality in SAH? Using a decomposition method, we find that inequality in SAH accounts for only about 10% of mortality inequality if interactions are not allowed for, but its contribution is increased to about 28% if account is taken of the reporting tendencies by age. In other words, omitting the interaction between age and SAH leads to a substantial underestimation of the partial contribution of SAH inequality by income. These results suggest that the often observed inequalities in SAH by income do have predictive power for the-less often observed-inequalities in survival by income.
本文使用一个大型的瑞典个体层面数据集实证研究了两个问题，该数据集将死亡率数据与健康调查数据相联系。第一个问题是个体的自我评估健康状况（SAH）对其后续生存概率是否有影响，以及这种影响是否因社会经济因素而异。我们的结果表明，SAH对死亡风险的影响随年龄增长而下降——这可能是因为在较高年龄时向“更温和”的总体健康评估调整——但似乎不因收入或教育等社会经济地位（SES）指标而有所不同。这一发现表明，SES对SAH没有系统性调整，因此，SAH中任何测量到的与收入相关的不平等不太可能因报告误差而产生偏差。第二个问题是：SAH中与收入相关的不平等能在多大程度上解释死亡率中与收入相关的不平等？使用一种分解方法，我们发现，如果不考虑相互作用，SAH中的不平等仅占死亡率不平等的约10%，但如果考虑年龄的报告倾向，其贡献会增加到约28%。换句话说，忽略年龄与SAH之间的相互作用会导致对SAH不平等按收入的部分贡献的大幅低估。这些结果表明，经常观察到的SAH按收入的不平等确实对较少观察到的生存按收入的不平等具有预测能力。
