Department of Public Health, University of Otago, Wellington School of Medicine and Health Sciences, 3 Mein St, Newtown, Wellington, New Zealand.
Soc Sci Med. 2011 Jan;72(2):193-201. doi: 10.1016/j.socscimed.2010.10.029. Epub 2010 Nov 20.
It is generally assumed that income is strongly and positively associated with health. However, much of the evidence supporting this assumption comes from cross-sectional data or analyses that have not fully accounted for biases from confounding and health selection (the reverse pathway from health to income). This paper reports results of a systematic review of panel and longitudinal studies investigating whether changes in income led to changes in self-rated health (SRH) in adults. A variety of electronic databases were searched, up until January 2010, and thirteen studies were included, using data from five different panel or longitudinal studies. The majority of studies found a small, positive and statistically significant association of income with SRH, which was much reduced after controlling for unmeasured confounders and/or health selection. Residual bias, particularly from measurement error, probably reduced this association to the null. Most studies investigated short-term associations between income and SRH or the effect of temporary (usually one year) income changes or shocks, so did not rule out possibly stronger associations between health and longer-term average income or income lagged over longer time periods. Nevertheless, the true causal short-term relationship between income and health, estimated by longitudinal studies of income change and SRH that control for confounding, may be much smaller than that suggested by previous, mostly cross-sectional, research.
人们普遍认为，收入与健康呈强正相关。然而，支持这一假设的大部分证据来自横断面数据或分析，这些数据没有充分考虑到混杂和健康选择（从健康到收入的反向途径）带来的偏差。本文报告了对调查收入变化是否导致成年人自评健康（SRH）变化的面板和纵向研究的系统评价结果。截至 2010 年 1 月，我们对各种电子数据库进行了搜索，并纳入了 13 项研究，这些研究的数据来自于五项不同的面板或纵向研究。大多数研究发现收入与 SRH 呈正相关且具有统计学意义，但在控制了未测量的混杂因素和/或健康选择后，这种相关性大大降低。残留的偏差，特别是来自测量误差的偏差，可能使这种相关性趋于零。大多数研究调查了收入与 SRH 之间的短期关联，或短期（通常为一年）收入变化或冲击的影响，因此不能排除健康与长期平均收入或更长时期滞后收入之间可能存在更强的关联。然而，通过控制混杂因素的收入变化和 SRH 的纵向研究估计的收入与健康之间的真实短期因果关系，可能比之前的大部分横断面研究所表明的要小得多。
