Daponte-Codina Antonio, Bolívar-Muñoz Julia, Toro-Cárdenas Silvia, Ocaña-Riola Ricardo, Benach-Rovira Joan, Navarro-López Vicente
Escuela Andaluza de Salud Pública, Granada, Spain.
Scand J Public Health. 2008 Jul;36(5):504-15. doi: 10.1177/1403494807088454. Epub 2008 Jun 20.
This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001.
The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated.
At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06-3.38) in 1987 to OR=3.62 (95% CI: 2.95-4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89-2.72) and OR=2.94 (95% CI: 2.36-3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39-5.45) in 1987 to 4.85 (95% CI: 3.06-7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39-3.08) and OR=4.16 (95% CI: 2.52-6.89).
Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.
本研究考察了1987年至2001年间，个人社会地位和城市地区贫困水平对西班牙自评健康不平等趋势的影响。
该研究基于1987年、1993年、1995年、1997年和2001年西班牙国家健康调查的横断面数据（n = 84,567）。所使用的指标为教育水平、职业阶层，以及作为城市地区指标的贫困水平。构建了多层次逻辑回归模型，个体嵌套于城市地区之中。估计了比值比（OR）和95%置信区间（CI）。为评估趋势，计算了不平等相对指数。
在个体层面，与研究生学历者相比，未接受正规教育者健康状况不佳的可能性，在女性中从1987年的OR = 2.66（95% CI：2.06 - 3.38）增至2001年的OR = 3.62（95% CI：2.95 - 4.63）。男性的相应数值分别为OR = 2.27（95% CI：1.89 - 2.72）和OR = 2.94（95% CI：2.36 - 3.68）。与最低贫困水平地区相比，生活在最高贫困水平地区会系统性地增加健康状况不佳的可能性。在贫困水平最高的城市地区，与研究生学历女性相比，未接受正规教育女性报告健康状况不佳的可能性从1987年的OR = 3.61（95% CI：2.39 - 5.45）增至2001年的4.85（95% CI：3.06 - 7.69）。在男性中，相应幅度为OR = 2.07（95% CI：1.39 - 3.08）和OR = 4.16（95% CI：2.52 - 6.89）。
在此期间，西班牙自评健康的不平等有所增加。这些不平等可能由整个参考期内存在的社会状况所解释，且模式因性别、城市地区贫困水平以及所使用的个人社会地位指标而异。
