谁的健康受到收入不平等的影响?美国州收入不平等对个人自评健康的同期和滞后效应的多层次交互分析。

Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States.

作者信息

Subramanian S V, Kawachi Ichiro

机构信息

Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, KRESGE, 7th Floor, Boston, MA 02115-6096, USA.

出版信息

Health Place. 2006 Jun;12(2):141-56. doi: 10.1016/j.healthplace.2004.11.001. Epub 2005 Jan 18.

Abstract

The empirical relationship between income inequality and health has been much debated and discussed. Recent reviews suggest that the current evidence is mixed, with the relationship between state income inequality and health in the United States (US) being perhaps the most robust. In this paper, we examine the multilevel interactions between state income inequality, individual poor self-rated health, and a range of individual demographic and socioeconomic markers in the US. We use the pooled data from the 1995 and 1997 Current Population Surveys, and the data on state income inequality (represented using Gini coefficient) from the 1990, 1980, and 1970 US Censuses. Utilizing a cross-sectional multilevel design of 201,221 adults nested within 50 US states we calibrated two-level binomial hierarchical mixed models (with states specified as a random effect). Our analyses suggest that for a 0.05 change in the state income inequality, the odds ratio (OR) of reporting poor health was 1.30 (95% CI: 1.17-1.45) in a conditional model that included individual age, sex, race, marital status, education, income, and health insurance coverage as well as state median income. With few exceptions, we did not find strong statistical support for differential effects of state income inequality across different population groups. For instance, the relationship between state income inequality and poor health was steeper for whites compared to blacks (OR=1.34; 95% CI: 1.20-1.48) and for individuals with incomes greater than $75,000 compared to less affluent individuals (OR=1.65; 95% CI: 1.26-2.15). Our findings, however, primarily suggests an overall (as opposed to differential) contextual effect of state income inequality on individual self-rated poor health. To the extent that contemporaneous state income inequality differentially affects population sub-groups, our analyses suggest that the adverse impact of inequality is somewhat stronger for the relatively advantaged socioeconomic groups. This pattern was found to be consistent regardless of whether we consider contemporaneous or lagged effects of state income inequality on health. At the same time, the contemporaneous main effect of state income inequality remained statistically significant even when conditioned for past levels of income inequality and median income of states.

摘要

收入不平等与健康之间的经验关系一直备受争议和讨论。近期的综述表明,目前的证据喜忧参半,美国州收入不平等与健康之间的关系可能最为显著。在本文中,我们研究了美国州收入不平等、个人自评健康状况不佳以及一系列个人人口统计学和社会经济指标之间的多层次相互作用。我们使用了1995年和1997年当前人口调查的汇总数据,以及1990年、1980年和1970年美国人口普查中关于州收入不平等的数据(用基尼系数表示)。利用嵌套在50个美国州内的201,221名成年人的横断面多层次设计,我们校准了二级二项式分层混合模型(将州指定为随机效应)。我们的分析表明,在一个包含个人年龄、性别、种族、婚姻状况、教育程度、收入、医疗保险覆盖范围以及州中位数收入的条件模型中,州收入不平等每变化0.05,报告健康状况不佳的优势比(OR)为1.30(95%置信区间:1.17 - 1.45)。除了少数例外情况,我们没有发现州收入不平等对不同人群有显著差异影响的有力统计支持。例如,与黑人相比,白人中州收入不平等与健康状况不佳之间的关系更为明显(OR = 1.34;95%置信区间:1.20 - 1.48),与收入较低的个人相比,收入超过75,000美元的个人中这种关系更为明显(OR = 1.65;95%置信区间:1.26 - 2.15)。然而,我们的研究结果主要表明州收入不平等对个人自评健康状况不佳存在总体(而非差异)的背景效应。就同期州收入不平等对不同人群亚组有差异影响而言,我们的分析表明,不平等对相对优势社会经济群体的不利影响略强。无论我们考虑州收入不平等对健康的同期效应还是滞后效应,都发现这种模式是一致的。同时,即使在考虑了过去的收入不平等水平和州中位数收入的条件下,州收入不平等的同期主效应在统计上仍然显著。

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