McGrail Kimberlyn M, van Doorslaer Eddy, Ross Nancy A, Sanmartin Claudia
Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada.
Am J Public Health. 2009 Oct;99(10):1856-63. doi: 10.2105/AJPH.2007.129361. Epub 2009 Jan 15.
We examined income-related inequalities in self-reported health in the United States and Canada and the extent to which they are associated with individual-level risk factors and health care system characteristics.
We estimated income inequalities with concentration indexes and curves derived from comparable survey data from the 2002 to 2003 Joint Canada-US Survey of Health. Inequalities were then decomposed by regression and decomposition analysis to distinguish the contributions of various factors.
The distribution of income accounted for close to half of income-related health inequalities in both the United States and Canada. Health care system factors (e.g., unmet needs and health insurance status) and risk factors (e.g., physical inactivity and obesity) contributed more to income-related health inequalities in the United States than to those in Canada.
Individual-level health risk factors and health care system characteristics have similar associations with health status in both countries, but they both are far more prevalent and much more concentrated among lower-income groups in the United States than in Canada.
我们研究了美国和加拿大自我报告健康状况中与收入相关的不平等现象,以及这些不平等与个体层面风险因素和医疗保健系统特征的关联程度。
我们使用集中指数和曲线来估计收入不平等,这些指数和曲线来自2002年至2003年加拿大 - 美国健康联合调查的可比调查数据。然后通过回归和分解分析对不平等进行分解,以区分各种因素的贡献。
在美国和加拿大,收入分配占与收入相关的健康不平等的近一半。医疗保健系统因素(如未满足的需求和医疗保险状况)和风险因素(如身体活动不足和肥胖)对美国与收入相关的健康不平等的贡献比对加拿大的贡献更大。
个体层面的健康风险因素和医疗保健系统特征在两国与健康状况的关联相似,但在美国,它们在低收入群体中比在加拿大更为普遍且更为集中。