von dem Knesebeck Olaf, Lüschen Günther, Cockerham William C, Siegrist Johannes
Department of Medical Sociology, University of Duesseldorf, P.O. Box 10 10 07, D-40001 Duesseldorf, Germany.
Soc Sci Med. 2003 Nov;57(9):1643-52. doi: 10.1016/s0277-9536(03)00020-0.
This study investigates socioeconomic status (SES) differences in health among the aged in Germany and the United States. Intra-elderly age differences in the SES-health gradient are also examined. The study uses data from two national telephone surveys conducted in Germany (N=682) and the United States (N=608) using probability samples of non-institutionalised persons 60 years or older. In addition to the traditional indicators of SES (education, income and occupational status), two alternative indicators (assets and home ownership) are utilised. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results of multiple logistic regression analyses show that income is the best SES predictor of the three health measures among the aged in Germany, whereas education, occupational prestige, assets, and home ownership are not consistently related to health. Respective analyses of the US data demonstrate weaker and less consistent associations of health measures with SES indicators. Consequently, there is a higher percentage of explained variance in health by SES among the aged in Germany compared to the United States. The data also show that social inequalities in health tend to diminish at older ages in the United States, but such disparities vary only slightly by age in Germany. In conclusion, although SES health differences are observed among the elderly in both countries, they are more pronounced in Germany than in the United States where effects are restricted to younger old age. One interpretation of this finding points to higher selective mortality of middle and early old age groups with a low SES in the United States due to stronger health-related deprivation.
本研究调查了德国和美国老年人健康方面的社会经济地位（SES）差异。同时也考察了老年人内部年龄差异对SES-健康梯度的影响。该研究使用了来自德国（N = 682）和美国（N = 608）的两项全国性电话调查数据，这些数据采用了60岁及以上非机构化人员的概率样本。除了SES的传统指标（教育程度、收入和职业地位）外，还使用了两个替代指标（资产和住房所有权）。自我评定健康状况、抑郁（CES-D）和功能受限情况被用作健康指标。多元逻辑回归分析结果表明，在德国老年人中，收入是这三项健康指标中SES的最佳预测因素，而教育程度、职业声望、资产和住房所有权与健康状况的关系并不一致。对美国数据的相应分析表明，健康指标与SES指标之间的关联较弱且不太一致。因此，与美国相比，德国老年人中SES对健康状况差异的解释比例更高。数据还显示，美国健康方面的社会不平等在老年时往往会减少，但在德国，这种差异在不同年龄段之间变化不大。总之，尽管在这两个国家的老年人中都观察到了SES与健康的差异，但在德国比在美国更为明显，在美国这种影响仅限于较年轻的老年人。这一发现的一种解释是，由于与健康相关的剥夺更强，美国SES较低的中年和老年早期群体的选择性死亡率更高。
