Economics, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3.
Soc Sci Med. 2010 Mar;70(6):802-12; discussion 813-5. doi: 10.1016/j.socscimed.2009.08.043. Epub 2010 Feb 1.
In their much-cited paper, "Can patient self-management help explain the SES health gradient?"Goldman and Smith (2002) use samples of diabetic and HIV+ patients in the United States to conclude that disease self-management is an important explanation for the much-documented positive gradient in education and health outcomes. In this paper, I revisit their analysis and point to some fundamental difficulties in interpreting their results as conclusive evidence in favor of self-management. I also argue that for individuals for whom self-management might be expected to matter -i.e. populations of patients managing complex conditions - economic factors such as resource availability and insurance access might be a more important mechanism behind the gradient than medical compliance. The impact of self-management, though it might matter, is likely to be small.
在他们广受引用的论文《患者自我管理能否解释 SES 健康梯度现象？》中，Goldman 和 Smith（2002）利用美国的糖尿病和 HIV+患者样本得出结论，即疾病自我管理是解释教育和健康结果呈正梯度分布的重要因素，这一现象在之前的研究中已有大量记录。在本文中，我重新审视了他们的分析，并指出了一些基本困难，即难以将其结果解释为支持自我管理的决定性证据。我还认为，对于那些自我管理可能很重要的个体，即管理复杂疾病的患者群体，资源的可获得性和保险的可及性等经济因素可能是梯度背后比医疗依从性更重要的机制。尽管自我管理可能很重要，但它的影响可能很小。
