Bosma H, Diederiks J P, van Santen H M S, van Eijk J Th M
Universiteit Maastricht, Instituut CAPHRI, sectie Medische Sociologie, Postbus 6i6, 6200 MD Maastricht.
Ned Tijdschr Geneeskd. 2005 Aug 20;149(34):1898-902.
To determine whether income is connected with the variation in the social exclusion of chronically ill patients.
Descriptive.
In 223 chronically ill patients that had been detected via patients' associations, general practitioners and outpatient clinics, a structured interview was administered during a home visit 4 times during a period of 7 months (October 2003-April 2004). Due to dropouts, the actual number of patients interviewed at each of the 4 times was 223, 176, 143 and 105, respectively. Social exclusion was measured with the aid of the 'Autonomy outside the home' subscale of the 'Impact on participation and autonomy' questionnaire. The possible total score varied from 5 (little social exclusion) to 25 (much social exclusion). In order to explain a possible effect of income, various other patient characteristics were added to the analysis model: type of primary disease (rheumatism, multiple sclerosis, pulmonary emphysema, other), duration of the primary disease, comorbidity, educational level, whether or not the patient was employed or engaged in volunteer work, whether or not the patient lived together with a partner, the self-rated health, physical functioning, social functioning, mental functioning, and the subjective pain. The data were analysed by means of multilevel repeated regression analysis.
A low income was associated with social exclusion at all 4 times of measurement. The regression coefficient of income was -1.47 (95% CI: -2.28- -0.65), indicating that the score on the scale for social exclusion decreased by 1.47 for every euro 544,- (= 1 x SD) increase in net monthly income. This relationship could not be explained by the other patient characteristics, not even by a low educational level.
The supportive care intended for the prevention of social exclusion of chronically ill patients should be concentrated sufficiently on those who have too little income to organise such care for themselves.
确定收入是否与慢性病患者社会排斥的变化相关。
描述性研究。
通过患者协会、全科医生和门诊诊所筛查出223名慢性病患者，在7个月（2003年10月至2004年4月）的时间里，进行了4次家访并实施结构化访谈。由于有患者退出，4次访谈实际受访患者人数分别为223名、176名、143名和105名。借助“对参与和自主性的影响”问卷中的“家庭外自主性”子量表来衡量社会排斥。可能的总分从5分（社会排斥程度低）到25分（社会排斥程度高）不等。为了解释收入可能产生的影响，在分析模型中加入了患者的其他各种特征：原发性疾病类型（风湿、多发性硬化、肺气肿、其他）、原发性疾病病程、合并症、教育程度、患者是否就业或从事志愿工作、患者是否与伴侣同住、自评健康状况、身体功能、社会功能、心理功能以及主观疼痛。采用多水平重复回归分析对数据进行分析。
在所有4次测量中，低收入均与社会排斥相关。收入的回归系数为-1.47（95%可信区间：-2.28至-0.65），这表明每月净收入每增加544欧元（=1个标准差），社会排斥量表得分就降低1.47分。这种关系无法用患者的其他特征来解释，即使是低教育程度也无法解释。
旨在预防慢性病患者社会排斥的支持性护理应充分关注那些收入过低而无法自行安排此类护理的患者。
