Domínguez-Berjón Felícitas, Borrell Carme, Rodríguez-Sanz Maica, Pastor Vicente
Servicio de Salud Pública del Area 2, Instituto de Salud Pública, Comunidad de Madrid, Spain.
Eur J Public Health. 2006 Feb;16(1):54-61. doi: 10.1093/eurpub/cki069. Epub 2005 Aug 10.
The study objective was to investigate the association between health outcomes and several small-area-based socioeconomic measures and also with individual socioeconomic measures as a check on external validity.
Cross-sectional design based on the analysis of the Barcelona Health Interview Survey of 1992. A representative stratified sample of the non-institutionalised population resident in Barcelona city (Spain) was obtained. The present study refers to the 4171 respondents aged over 14. We studied perceived health status, presence of chronic conditions and smoking as health outcomes. Area socioeconomic measures (1991 census) were generated at census tract level and individual socioeconomic measures were educational level and social class obtained through the survey.
With individual socioeconomic measures we observed that the lower the educational level or social class, the higher the probability of reporting a perceived health status of fair, poor or very poor and of presenting some chronic condition. With regard to smoking, among men this trend was similar [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.2-1.9 in social classes IV-V with respect to social classes I-II], while among women it was reversed (OR = 0.7; 95% CI = 0.5-0.9). With the different area-based socioeconomic indicators differences were also observed in this sense, with the exception of smoking in women for which these indicators do not show any differences by socioeconomic level.
With several census area-based socioeconomic measures similar effects on inequalities in health have been observed. In general, these inequalities were in the same sense as those obtained with individual-based measures. Small-area-based socioeconomic measures from the Spanish census could greatly enhance analysis of social inequalities in health, overcoming the absence of socioeconomic data in public health registries and in medical records.
本研究的目的是调查健康结果与几种基于小区域的社会经济指标之间的关联，并与个体社会经济指标进行比较，以检验外部有效性。
基于对1992年巴塞罗那健康访谈调查的分析采用横断面设计。获得了居住在巴塞罗那市（西班牙）的非机构化人口的代表性分层样本。本研究涉及4171名年龄在14岁以上的受访者。我们将自我感知的健康状况、慢性病的存在情况和吸烟情况作为健康结果进行研究。区域社会经济指标（1991年人口普查数据）在普查小区层面生成，个体社会经济指标是通过调查获得的教育水平和社会阶层。
对于个体社会经济指标，我们观察到教育水平或社会阶层越低，报告自我感知健康状况为一般、较差或非常差以及患有某些慢性病的概率就越高。关于吸烟，在男性中这种趋势类似[优势比（OR）= 1.5；社会阶层IV - V相对于社会阶层I - II的95%置信区间（CI）= 1.2 - 1.9]，而在女性中则相反（OR = 0.7；95% CI = 0.5 - 0.9）。对于不同的基于区域的社会经济指标，在这方面也观察到了差异，但女性吸烟情况除外，这些指标在社会经济水平方面未显示出任何差异。
观察到几种基于普查区域的社会经济指标对健康不平等有类似影响。总体而言，这些不平等与基于个体指标所获得的不平等方向相同。来自西班牙人口普查的基于小区域的社会经济指标可以极大地加强对健康方面社会不平等的分析，克服公共卫生登记处和医疗记录中缺乏社会经济数据的问题。
