Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Epidemiol. 2011;21(4):278-84. doi: 10.2188/jea.je20100131. Epub 2011 May 21.
Previous research has investigated differences in the predictive power of self-rated health (SRH) for mortality based on socioeconomic status (SES). However, these studies mainly assessed adults in the general population and did not focus specifically on elderly adults. In addition, this predictive power has never been evaluated using subjective SES, which is an important measure of SES in elderly adults.
This study used data from the Survey of the Health and Living Status of the Middle Aged and the Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Taiwan. The SHLS is a 15-year longitudinal survey based on a nationally representative sample. It was initiated in 1989 with 4049 respondents aged 60 years or older. Both education and subjective financial satisfaction were used as SES measures in the present study. A Cox regression model was used to estimate the interaction between SRH and SES for 3829 individuals without missing data.
As compared with those who reported their health as good, those who reported their health as poor and their education as high had a higher hazard ratio (hazard ratio = 1.97, 95% confidence interval = 1.35-2.88) for 6-15-year mortality, after adjusting for depressive symptoms, activities of daily living, and instrumental activities of daily living. This HR was significantly higher than those for adults with middle (1.16, 0.93-1.44) and low (1.27, 1.05-1.54) education, based on the χ(2) test (P < 0.05 for both comparisons). A similar pattern was observed when financial satisfaction was used as the SES measure. However, the pattern was attenuated when using 5-year mortality from baseline.
The use of SRH as a single health measure in elderly adults may yield inconsistent results across different SES groups, especially when used as a predictor of a longer-term mortality. This is true regardless of whether objective or subjective measures of SES are used, where both are important measures of SES in elderly adults.
先前的研究已经调查了基于社会经济地位（SES）的自评健康（SRH）对死亡率的预测能力的差异。然而，这些研究主要评估了一般人群中的成年人，并没有专门针对老年人。此外，这种预测能力从未使用主观 SES 进行过评估，主观 SES 是老年人 SES 的一个重要衡量标准。
本研究使用了台湾健康促进局进行的《台湾中老年健康与生活状况调查》（SHLS）的数据。SHLS 是一项基于全国代表性样本的 15 年纵向调查。它于 1989 年以 4049 名 60 岁或以上的受访者为基础开始。在本研究中，教育程度和主观财务满意度均被用作 SES 衡量标准。对于没有缺失数据的 3829 个人，使用 Cox 回归模型来估计 SRH 和 SES 之间的交互作用。
与报告健康状况良好的人相比，报告健康状况较差且教育程度较高的人，在调整了抑郁症状、日常生活活动和工具性日常生活活动后，其 6-15 年死亡率的危险比（危险比=1.97，95%置信区间=1.35-2.88）更高。基于 χ²检验，这一 HR 明显高于中等（1.16，0.93-1.44）和低（1.27，1.05-1.54）教育程度的成年人（两者均<0.05）。当使用财务满意度作为 SES 衡量标准时，观察到了类似的模式。然而，当使用从基线开始的 5 年死亡率时，该模式会减弱。
在老年人中，将 SRH 用作单一健康衡量标准可能会导致不同 SES 群体之间的结果不一致，尤其是在用作长期死亡率的预测指标时。无论使用客观 SES 还是主观 SES 衡量标准，这都是如此，因为这两种衡量标准都是老年人 SES 的重要衡量标准。
