Center for Health Services Research and Development, American University of Armenia, Yerevan 0019, Armenia.
Int J Equity Health. 2008 Dec 12;7:25. doi: 10.1186/1475-9276-7-25.
The former soviet Republic of Armenia entered a turbulent and long-lasting economic transition when it declared its independence in 1991. This analysis sought to identify the determinants of poor self-rated health as an indirect measure of health status and mortality prognosis in an adult female population during a period of socio-economic transition in Armenia.
Differences in self-rated health in women respondents were analyzed along three main dimensions: social, behavioral/attitudinal, and psychological. The data used were generated from cross-sectional household health surveys conducted in Armavir marz in 2001 and 2004. The surveys utilized the same instruments and study design (probability proportional to size, multistage cluster sampling with a combination of interviewer-administered and self-administered surveys) and generated two independent samples of households representative of Armavir marz. Binary logistic regression models with self-rated health as the outcome were fitted to the 2001 and 2004 datasets and a combined 2001/2004 dataset.
Overall, 2 038 women aged 18 and over participated in the two surveys (1 019 in each). The rate of perceived "poor" health was relatively high in both surveys: 38.1% in 2001 and 27.0% in 2004. The sets of independent predictors of poor self-rated health were similar in all three models and included severe and moderate material deprivation, probable and possible depression, low level of education, and having ever smoked. These predictors mediated the effect of women's economic activity (including unemployment), ethnicity, low access to/utilization of healthcare services, and living alone on self-rated health.
Material deprivation was the most influential predictor of self-rated health. Thus, social reforms to decrease the gap between the rich and poor are recommended as a powerful tool for reducing health inequalities and improving the health status of the population.
1991 年，前苏联加盟共和国亚美尼亚宣布独立，进入了一个动荡而持久的经济转型期。本分析旨在确定在亚美尼亚社会经济转型期间，女性人口中自我评估健康状况较差的决定因素，这是健康状况和死亡率预测的间接指标。
分析了女性受访者在社会、行为/态度和心理三个主要方面自我评估健康状况的差异。所使用的数据是在 2001 年和 2004 年在阿尔马维尔州进行的横断面家庭健康调查中生成的。这些调查采用了相同的工具和研究设计（按大小比例概率、多阶段聚类抽样，结合访谈者管理和自我管理的调查），生成了两个代表阿尔马维尔州的独立家庭样本。以自我评估健康状况为结果的二元逻辑回归模型分别拟合到 2001 年和 2004 年的数据集以及 2001/2004 年的综合数据集。
总的来说，共有 2038 名 18 岁及以上的女性参加了这两项调查（每项调查 1019 人）。在两项调查中，感知“健康状况差”的比例都相对较高：2001 年为 38.1%，2004 年为 27.0%。所有三个模型中自我评估健康状况较差的独立预测因素相似，包括严重和中度物质匮乏、可能和可能的抑郁、低教育水平以及曾经吸烟。这些预测因素调解了女性经济活动（包括失业）、种族、获得/利用医疗保健服务的机会低以及独居对自我评估健康状况的影响。
物质匮乏是自我评估健康状况的最主要预测因素。因此，建议进行社会改革以缩小贫富差距，作为减少健康不平等和改善人口健康状况的有力工具。
