Harper Sam, Lynch John
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec.
Public Health Rep. 2007 Mar-Apr;122(2):177-89. doi: 10.1177/003335490712200207.
The purpose of this study was to measure state trends in educational inequalities in smoking, binge alcohol use, physical inactivity, obesity, and seatbelt use.
The authors calculated the Relative Concentration Index of educational inequality for five health behaviors on adults from all 50 states and the District of Columbia using data from 1990 to 2004 in the Behavioral Risk Factor Surveillance System (n=2,118,562). Linear regression was used to measure changes and trends in the Relative Concentration Index of health inequality across education groups in each state.
Except for binge alcohol use, poorer health behaviors were concentrated among the less educated. The largest educational inequalities were for physical inactivity. From 1990 to 2004, significant increases in relative educational inequalities occurred in 40 states for smoking and 31 states for physical inactivity. For binge alcohol use, 27 states showed significant declining inequality trends, but educational inequalities reversed direction and binge alcohol use is now more prevalent among the less educated in 19 states. Significant decreases in educational inequalities occurred in 36 states for obesity and 24 states for seat belt use. Changes in educational inequalities across the different health behaviors were not associated, except for a modest correlation between changes in inequality in smoking and binge alcohol use (r=0.40; p=0.004). Similarly, there was little association between changes in the population prevalence of health behaviors and changes in educational inequality in health behaviors, with substantial heterogeneity among states.
State trends in relative educational inequality among health behaviors were mixed, increasing for smoking and physical inactivity and decreasing for obesity and seat belt use. The factors influencing relative inequality trends may differ from those affecting overall prevalence trends.
本研究旨在衡量吸烟、酗酒、缺乏身体活动、肥胖和安全带使用方面教育不平等的州级趋势。
作者利用行为风险因素监测系统中1990年至2004年的数据（n = 2,118,562），计算了50个州和哥伦比亚特区成年人在五种健康行为上的教育不平等相对集中指数。采用线性回归来衡量每个州不同教育群体间健康不平等相对集中指数的变化和趋势。
除酗酒外，较差的健康行为集中在受教育程度较低者中。最大的教育不平等存在于缺乏身体活动方面。从1990年到2004年，40个州在吸烟方面以及31个州在缺乏身体活动方面的相对教育不平等显著增加。对于酗酒，27个州显示不平等趋势显著下降，但19个州的教育不平等出现反转，现在酗酒在受教育程度较低者中更为普遍。36个州在肥胖方面以及24个州在安全带使用方面的教育不平等显著下降。不同健康行为间教育不平等的变化没有关联，除了吸烟和酗酒不平等变化之间存在适度相关性（r = 0.40；p = 0.004）。同样，健康行为人群患病率的变化与健康行为教育不平等的变化之间几乎没有关联，各州之间存在很大异质性。
健康行为方面相对教育不平等的州级趋势参差不齐，吸烟和缺乏身体活动方面增加，肥胖和安全带使用方面减少。影响相对不平等趋势的因素可能与影响总体患病率趋势的因素不同。
