Daoud Nihaya, Soskolne Varda, Manor Orly
The Braun School of Public Health, Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel.
Eur J Public Health. 2009 Oct;19(5):477-83. doi: 10.1093/eurpub/ckp080. Epub 2009 Jun 23.
Studies on factors explaining the socioeconomic inequalities in health within ethnic minorities are scarce. This study examines the contribution of material conditions, and psychosocial, community, cultural and behavioural factors to explaining educational disparities in self-rated health (SRH) within the Arab minority in Israel.
In 2005, a national random sample of 902 persons aged 30-70 was selected in a multistage sampling procedure for interviewing. We used multistage logistic regression modelling to examine the percent of attenuations in odds ratios (OR) of extreme categories for education (low vs. high) in the associations with SRH after inclusion of explanatory variables.
Education was significantly associated with SRH [odds ratio (OR) = 3.86, 95% confidence interval (CI) = 2.30-6.47]. The separate inclusion of material conditions reduced the OR of poor SRH by 43%. Psychosocial, community or behavioural variables reduced it by 17%, 26% and 11%, respectively. Combining each group of factors with material conditions led to small additional reductions in OR. Integrating all explanatory variables reduced OR by 54%, with the association becoming non-significant. Cultural variables were not associated with SRH and were therefore not included in the multivariate analysis.
Material conditions are a major factor in explaining the educational disparities in SRH among Arabs in Israel. Most of the impact of psychosocial and health behaviours, together with part of the community effects, operated through material conditions. Reduction of educational inequalities in SRH requires provision of educational attainment opportunities accompanied by employment opportunities assuring equivalent material gains. Further examination of factors explaining health inequalities among other minorities is warranted.
关于解释少数族裔健康方面社会经济不平等的因素的研究较少。本研究探讨物质条件、心理社会、社区、文化和行为因素对解释以色列阿拉伯少数族裔自评健康（SRH）教育差异的贡献。
2005年，采用多阶段抽样程序选取了902名年龄在30 - 70岁的全国随机样本进行访谈。我们使用多阶段逻辑回归模型来检验在纳入解释变量后，教育程度（低与高）极端类别与SRH关联中优势比（OR）的衰减百分比。
教育与SRH显著相关[优势比（OR） = 3.86，95%置信区间（CI） = 2.30 - 6.47]。单独纳入物质条件使SRH差的OR降低了43%。心理社会、社区或行为变量分别使其降低了17%、26%和11%。将每组因素与物质条件相结合导致OR有小幅额外降低。整合所有解释变量使OR降低了54%，该关联变得不显著。文化变量与SRH无关，因此未纳入多变量分析。
物质条件是解释以色列阿拉伯人SRH教育差异的主要因素。心理社会和健康行为的大部分影响以及部分社区效应是通过物质条件起作用的。减少SRH方面的教育不平等需要提供教育成就机会并伴有确保同等物质收益的就业机会。有必要进一步研究解释其他少数族裔健康不平等的因素。
