CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
Eur J Public Health. 2012 Aug;22(4):587-92. doi: 10.1093/eurpub/ckr063. Epub 2011 Jun 6.
Taking into account our rapidly ageing population, older people are of particular interest in studying health inequalities. The aim of the present study is to examine the relation between socio-economic status and health-related functioning in older people and to find out how material factors (e.g. the lack of basic goods) and psychosocial factors (e.g. low self-efficacy) compare regarding the explanation of these socio-economic differences.
Data came from 5061 Dutch men and women aged ≥ 55 years who participated in the longitudinal Study on Medical Information and Lifestyles Eindhoven (SMILE) study. Baseline data were collected between November 2002 and May 2004 and respondents were followed until May 2009 (follow-up range: 0-5 years). Multilevel analyses were used to study the association between educational level and longitudinal changes in physical and mental functioning (i.e. two subscales of the SF-36) and to study the relative contribution of material and psychosocial factors to this relation.
Low educational level was associated with poor initial physical and mental functioning. However, no further widening of these gradients was found during follow-up. Material factors reduced the initial educational differences by an average of 29%, whereas psychosocial factors, mastery and self-efficacy in particular, reduced these differences by an average of 60%.
More than material factors, psychosocial factors, mastery and self-efficacy in particular, explained a large part of the educational differences in physical and mental functioning in older people. Further research is recommended to explore the amenability to change of characteristics that hamper people from taking control over their lives.
考虑到人口老龄化速度加快，老年人在研究健康不平等方面具有特别的意义。本研究的目的是检验老年人社会经济地位与健康相关功能之间的关系，并确定物质因素（如缺乏基本物品）和心理社会因素（如自我效能感低）在解释这些社会经济差异方面的相对重要性。
数据来自 5061 名年龄≥55 岁的荷兰男女，他们参加了纵向埃因霍温医学信息和生活方式研究（SMILE）。基线数据收集于 2002 年 11 月至 2004 年 5 月之间，受访者随访至 2009 年 5 月（随访范围：0-5 年）。多水平分析用于研究教育水平与身体和心理功能（即 SF-36 的两个子量表）的纵向变化之间的关系，并研究物质和心理社会因素对这种关系的相对贡献。
低教育水平与初始身体和心理功能较差相关。然而，在随访期间没有发现这些梯度进一步扩大。物质因素将初始教育差异平均缩小了 29%，而心理社会因素，特别是掌握感和自我效能感，将这些差异平均缩小了 60%。
与物质因素相比，心理社会因素，特别是掌握感和自我效能感，解释了老年人身体和心理功能中教育差异的很大一部分。建议进一步研究，以探讨阻碍人们控制自己生活的特征的可改变性。
