Sainio Päivi, Martelin Tuija, Koskinen Seppo, Heliövaara Markku
National Public Health Institute, Department of Health and Functional Capacity, Mannerheimintie 166, 00300 Helsinki, Finland.
J Epidemiol Community Health. 2007 May;61(5):401-8. doi: 10.1136/jech.2006.048306.
In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.
To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.
This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.
According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.
Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.
在早期研究中，尚未全面测量 mobility 方面社会经济梯度的决定因素。
评估慢性病、肥胖、吸烟和体力劳动负荷对 mobility 不平等的影响。
这是一项针对 2572 人的横断面研究（占芬兰 55 岁及以上具有全国代表性样本的 76%）。通过自我报告和表现率来测量 mobility 限制。
根据一系列自我报告和基于测试的指标，教育程度较低的人比教育程度较高的人表现出更多的 mobility 限制。与最高教育类别相比，最低教育类别的人爬楼梯受限的年龄调整后比值比为三倍（自我报告受限的男性为 3.3，女性为 2.9；基于测试受限的男性为 3.5，女性为 2.2）。当同时考虑肥胖、吸烟、与工作相关的体力负荷和临床诊断的慢性病时，爬楼梯受限方面的教育差异消失或大大减小。在女性中，肥胖对差异的影响最大，其次是从事体力要求高的工作史、膝关节和髋关节骨关节炎以及心血管疾病。在男性中，糖尿病、与工作相关的体力负荷、肌肉骨骼疾病、肥胖和吸烟对不平等有很大影响。
在 mobility 的各种测量指标中存在很大的教育不平等。常见慢性病、肥胖、吸烟和工作量似乎是从低教育水平到 mobility 受限的主要途径。因此，采用在最低教育水平群体中也能产生良好效果的方法进行一般健康促进是减少 mobility 差距的一个好策略。
