Zimmerman Frederick J, Bell Janice F
Department of Health Services and Child Health Institute, 6200 NE 74th Street, Suite 210, University of Washington, Seattle, WA 98115-8160, USA.
J Epidemiol Community Health. 2006 Jun;60(6):513-21. doi: 10.1136/jech.2005.040154.
To test associations between individual health outcomes and ecological variables proposed in causal models of relations between income inequality and health.
Regression analysis of a large, nationally representative dataset, linked to US census and other county and state level sources of data on ecological covariates. The regressions control for individual economic and demographic covariates as well as relevant potential ecological confounders.
The US population in the year 2000.
4817 US adults about age 40, representative of the US population.
Two outcomes were studied: self reported general health status, dichotomised as "fair" or "poor" compared with "excellent", "very good", or "good", and depression as measured by a score on the Center for Epidemiologic Studies depression instrument >16.
State generosity was significantly associated with a reduced odds of reporting poor general health (OR 0.84, 95%CI: 0.71 to 0.99), and the county unemployment rate with reduced odds of reporting depression (OR 0.91, 95%CI: 0.84 to 0.97). The measure of income inequality is a significant risk factor for reporting poor general health (OR 1.98, CI: 1.08 to 3.62), controlling for all ecological and individual covariates. In stratified models, the index of social capital is associated with reduced odds of reporting poor general health among black people and Hispanics (OR 0.40, CI: 0.18 to 0.90), but not significant among white people. The inequality measure is significantly associated with reporting poor general health among white people (OR 2.60, CI: 1.22 to 5.56) but not black people and Hispanics.
The effect of income inequality on health may work through the influence of invidious social comparisons (particularly among white subjects) and (among black subjects and Latinos) through a reduction in social capital. Researchers may find it fruitful to recognise the cultural specificity of any such effects.
检验个体健康结果与收入不平等和健康关系的因果模型中所提出的生态变量之间的关联。
对一个具有全国代表性的大型数据集进行回归分析，该数据集与美国人口普查以及其他县和州层面的生态协变量数据源相关联。回归分析控制了个体经济和人口统计学协变量以及相关的潜在生态混杂因素。
2000年的美国人口。
4817名年龄约40岁的美国成年人，代表美国人口。
研究了两个结局：自我报告的总体健康状况，分为“一般”或“差”，与“优秀”、“非常好”或“好”相对比；以及通过流行病学研究中心抑郁量表得分>16来衡量的抑郁。
州慷慨程度与报告总体健康状况差的几率显著降低相关（比值比0.84，95%置信区间：0.71至0.99），县失业率与报告抑郁的几率降低相关（比值比0.91，95%置信区间：0.84至0.97）。在控制所有生态和个体协变量的情况下，收入不平等指标是报告总体健康状况差的一个显著风险因素（比值比1.98，置信区间：1.08至3.62）。在分层模型中，社会资本指数与黑人及西班牙裔中报告总体健康状况差的几率降低相关（比值比0.40，置信区间：0.18至0.90），但在白人中不显著。不平等指标与白人中报告总体健康状况差显著相关（比值比2.
