Huisman Martijn, van Lenthe Frank, Mackenbach Johan
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Int J Epidemiol. 2007 Dec;36(6):1207-13. doi: 10.1093/ije/dym095. Epub 2007 May 17.
The purpose of this study was to assess potential differences in the predictive ability of self-assessed health for mortality between educational groups, and to find explanations for any of these educational differences.
We used data from the longitudinal GLOBE study, with a 13-year mortality follow-up. Analyses were performed for people aged between 25-74 years at baseline (n = 16,722). The associations of self-assessed health with mortality were estimated with Cox regression analyses, and the resulting hazard ratios were used as indicators of the 'predictive ability' of self-assessed health for mortality. Differences between educational levels were estimated by including an interaction term of education with self-assessed health in regression models with mortality as the outcome. The analyses were subsequently adjusted for: life threatening chronic conditions, non-life threatening conditions, stressors and health behaviour, to test the contribution of these factors to the predictive ability of self-assessed health.
Results indicated that the predictive ability of self-assessed health for mortality was greater in men with tertiary education as compared with the lowest educated men. No differences were observed in women. None of the four health aspects accounted for the educational difference in men.
Because differences in the predictive ability for mortality were limited to the extreme educational groups in men, educational differences in self-assessed health that are reported in numerous studies should not be expected to seriously overestimate educational differences in 'objective' health status.
本研究旨在评估不同教育程度群体中自我评估健康状况对死亡率的预测能力的潜在差异，并找出造成这些教育差异的原因。
我们使用了全球纵向研究的数据，并对死亡率进行了13年的随访。对基线年龄在25至74岁之间的人群（n = 16,722）进行了分析。通过Cox回归分析估计自我评估健康状况与死亡率之间的关联，并将所得的风险比用作自我评估健康状况对死亡率的“预测能力”指标。通过在以死亡率为结果的回归模型中纳入教育程度与自我评估健康状况的交互项，来估计教育水平之间的差异。随后对分析进行了调整，以考量危及生命的慢性病、非危及生命的疾病、压力源和健康行为，以检验这些因素对自我评估健康状况预测能力的贡献。
结果表明，与受教育程度最低的男性相比，受过高等教育的男性中自我评估健康状况对死亡率的预测能力更强。在女性中未观察到差异。四个健康方面中的任何一个都无法解释男性中的教育差异。
由于死亡率预测能力的差异仅限于男性中的极端教育群体，因此众多研究中报告的自我评估健康状况的教育差异，不应被认为会严重高估“客观”健康状况中的教育差异。
