Chen Edith, Martin Andrew D, Matthews Karen A
Department of Psychology, University of British Columbia, Vancouver, Canada.
Soc Sci Med. 2006 May;62(9):2161-70. doi: 10.1016/j.socscimed.2005.08.054. Epub 2005 Oct 6.
Socioeconomic status (SES) gradients may not be static across the lifespan, but instead may vary in strength across different life stages. This study examined the periods in childhood when SES and health relationships emerge and are strongest among US children. Data came from the National Health Interview Survey, 1994, a cross sectional, nationally representative sample of 33,911 US children ages 0-18. Parents were asked about family SES and child health status. Global health measures included overall ratings of child health, activity and school limitations. Acute conditions included childhood injuries and respiratory illnesses. For all global child health measures, lower family SES was associated with poorer child health in a gradient fashion (P < .001); these differences did not vary across age. For specific conditions, interaction effects of SES with age were found (P < .05). Interaction effects revealed that for injury and acute respiratory illness, expected SES gradients (lower SES with poorer outcomes) were evident during adolescence. In contrast, respiratory illness had a reverse SES gradient in early childhood. In sum, for global child health measures, associations of lower SES with poorer health throughout childhood suggest that factors that do not change with age (e.g., health care quality) may best explain overall health status. However, for acute conditions, the relationship between low SES and poor child health appears most consistently during adolescence. This suggests that normal development-related changes during adolescence, such as increasing peer group affiliation, may help explain these gradients. These patterns are important to understand for optimally timing interventions to reduce SES disparities in US children's health.
社会经济地位（SES）梯度在人的一生中可能并非一成不变，而是在不同生命阶段强度各异。本研究调查了美国儿童中SES与健康关系出现并最为显著的童年时期。数据来自1994年全国健康访谈调查，这是一个对33911名0至18岁美国儿童的横断面全国代表性样本。研究询问了家长有关家庭SES和儿童健康状况的问题。整体健康指标包括对儿童健康、活动和学校受限情况的总体评分。急性病症包括儿童期受伤和呼吸道疾病。对于所有儿童整体健康指标，较低的家庭SES与较差的儿童健康呈梯度相关（P <.001）；这些差异在各年龄段并无变化。对于特定病症，发现了SES与年龄的交互作用（P <.05）。交互作用表明，对于受伤和急性呼吸道疾病，预期的SES梯度（SES越低，结果越差）在青春期明显。相比之下，呼吸道疾病在幼儿期呈现相反的SES梯度。总之，对于儿童整体健康指标，较低的SES与整个童年期较差的健康之间的关联表明，不随年龄变化的因素（如医疗质量）可能最能解释总体健康状况。然而，对于急性病症，低SES与儿童健康不佳之间的关系在青春期最为一致。这表明青春期与发育相关的正常变化，如同伴群体联系的增加，可能有助于解释这些梯度。了解这些模式对于优化干预措施的时机以减少美国儿童健康方面的SES差距很重要。
