Germinal-Research Group on Chronic and Occupational Diseases, Medical School of the Federal University of Minas Gerais, Av. Prof. Alfredo Balena 190, 814, 30130100 Belo Horizonte, Minas Gerais, Brazil.
Soc Sci Med. 2010 Aug;71(4):815-23. doi: 10.1016/j.socscimed.2010.05.021. Epub 2010 Jun 4.
This work contributes to the study of the relationship between health, work and context by investigating the interaction between them in Brazil, a country with great social inequalities. It investigates whether unemployment and socioeconomic characteristics of the neighborhoods in which people live are associated with poor self-rated health after adjustment for individual sociodemographic characteristics, behavioral risk factors and health status. Moreover, it tests whether living in an area of socioeconomic deprivation modifies the association between unemployment and self-rated health. The study involved participants whose ages ranged from 15 up to 64 years, and who lived in four Brazilian cities included in the National Household Survey on Risk Behaviors and Reported Morbidity from Non-Communicable Diseases, carried out by the Ministry of Health in 2002/2003. Data from the 2000 Brazilian Population Census were used to calculate two neighborhood socioeconomic indicators: the proportion of householders with low income, a compositional variable of individual level characteristics, and residing in slums, a contextual variable not captured by individual properties. Logistic regression analysis was estimated by Generalized Estimating Equations. Of the 6426 participants, 20.6% reported poor self-rated health. Unemployment as well as residing in slums or in low income household areas were significantly associated with poor self-rated health. The magnitudes of these associations were attenuated after adjustment for sociodemographic characteristics, behavioral risk factors and other health status indicators. However, the association between unemployment and poor self-rated health was not modified by neighborhood socioeconomic indicators. Results confirm the association between unemployment and poor self-rated health, regardless of the personal or contextual characteristics studied here. Similarly, they show a clear independent association between self-rated health and neighborhood context. Even so, they do not show that the neighborhood contexts investigated modify the associations between unemployment and poor self-rated health.
这项工作通过研究巴西健康、工作和环境之间的相互作用，为健康、工作和环境之间的关系研究做出了贡献。巴西是一个社会不平等程度很高的国家，本研究旨在调查人们失业和居住社区的社会经济特征是否与调整个人社会人口统计学特征、行为风险因素和健康状况后的自评健康状况较差有关。此外，本研究还检验了生活在社会经济贫困地区是否会改变失业与自评健康之间的关系。该研究的参与者年龄在 15 至 64 岁之间，居住在巴西四个城市，这些城市均参与了 2002/2003 年由卫生部开展的国家家庭风险行为和非传染性疾病报告发病率调查。利用 2000 年巴西人口普查数据计算了两个社区社会经济指标：低收入家庭主比例，这是个人层面特征的构成变量，以及居住在贫民窟，这是个人特征无法捕捉的环境变量。使用广义估计方程估计了逻辑回归分析。在 6426 名参与者中，20.6%报告自评健康状况较差。失业以及居住在贫民窟或低收入家庭地区与自评健康状况较差显著相关。调整社会人口统计学特征、行为风险因素和其他健康状况指标后，这些关联的幅度减弱。然而，失业与自评健康状况较差之间的关联不受社区社会经济指标的影响。结果证实了失业与自评健康状况较差之间的关联，而与这里研究的个人或环境特征无关。同样，自评健康状况与社区环境之间也存在明显的独立关联。即便如此，研究结果并未表明所调查的社区环境会改变失业与自评健康状况较差之间的关联。
