Southern Danielle A, Faris Peter D, Knudtson Merril L, Ghali William A
University of Calgary, Calgary, AB, Department of Community Health Sciences.
Can J Public Health. 2006 Mar-Apr;97(2):114-7. doi: 10.1007/BF03405327.
Census-based measures of income derived from median income of a geographic area are often used in health research. Many national census surveys gather information on both the respondent's individual income and the income for the entire household, giving researchers a choice of census income measures. We compared the extent to which individual respondent income and household income (both obtained from census data) are associated with outcomes in a cohort of patients with cardiac disease.
We used data from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH), where postal codes were linked to the Postal Code Conversion File (PCCF) to determine each patient's census Dissemination Areas (DA). DA-derived median household income and median individual income were obtained from the 2001 Canadian Census and survival outcomes were then directly determined for income groupings defined by quintile. Two-year survival adjusted for age and sex was described with a proportional hazards analysis.
There were 9,397 patients undergoing cardiac catheterization between January 1, 2001 and March 31, 2002, with complete DA-level median income measures. Household income quintiles yielded a wider spread of survival across quintiles (range of 2-year estimated survival, 91.8% to 95.9% for household income versus 92.8% to 95.6% for respondent income), as well as a more progressive decline in survival as income decreased. This progressive decline was not seen for the respondent income measure.
The greater spread and progressive decline of survival for household income relative to respondent income leads us to conclude that household income is the better socio-economic determinant of health in our data and for the outcome measure we studied.
基于人口普查得出的某地理区域的收入中位数常被用于健康研究。许多国家人口普查会收集受访者个人收入和整个家庭收入的信息，这让研究人员可以选择不同的普查收入衡量指标。我们比较了个体受访者收入和家庭收入（均从普查数据中获取）与一组心脏病患者的预后之间的关联程度。
我们使用了来自阿尔伯塔省冠心病结局评估省级项目（APPROACH）的数据，通过邮政编码与邮政编码转换文件（PCCF）关联，以确定每位患者的普查传播区域（DA）。从2001年加拿大人口普查中获取基于DA的家庭收入中位数和个人收入中位数，然后直接确定按五分位数定义的收入分组的生存结局。采用比例风险分析描述经年龄和性别调整后的两年生存率。
在2001年1月1日至2002年3月31日期间，有9397例患者接受了心导管插入术，且有完整的基于DA水平的收入中位数测量值。家庭收入五分位数在各五分位数间的生存差异更大（家庭收入的两年估计生存率范围为91.8%至95.9%，而受访者收入为92.8%至95.6%），并且随着收入降低，生存率下降趋势更为明显。受访者收入衡量指标未出现这种逐渐下降的情况。
相对于受访者收入，家庭收入在生存率方面差异更大且呈逐渐下降趋势，这使我们得出结论，在我们的数据以及所研究的结局指标中，家庭收入是更好的社会经济健康决定因素。
