Department of Health Services, University of California, School of Public Health, Los Angeles, CA, USA.
Med Care. 2011 Nov;49(11):1021-30. doi: 10.1097/MLR.0b013e31822ebed9.
The purpose of the study was to examine whether gender differences in summary health-related quality of life (HRQoL) are due to differences in specific dimensions of health, and whether they are explained by sociodemographic and socioeconomic (SES) variation.
The National Health Measurement Study collected cross-sectional data on a national sample of 3648 black and white noninstitutionalized adults ages 35 to 89 years. Data included the Short Form 36-Item survey, which yielded separate Mental and Physical Component Summary scores (MCS and PCS, respectively), and five HRQoL indexes: Short Form 6 dimension, EuroQol 5 dimension, the Health Utilities Indexes Mark 2 and 3, and the Quality of Well-Being Scale Self-Administered form. Structural equation models were used to explore gender differences in physical, psychosocial, and pain latent dimensions of the 5 indexes, adjusting for sociodemographic and SES indicators. Observed MCS and PCS scores were examined in regression models to judge robustness of latent results.
Men had better estimated physical and psychosocial health and less pain than women with similar trends on the MCS and PCS scores. Adjustments for marital status or income reduced gender differences more than did other indicators. Adjusting results for partial factorial invariance of HRQoL attributes supported the presence of gender differentials, but also indicated that these differences are impacted by dimensions being related to some HRQoL attributes differently by gender.
Men have better estimated health on 3 latent dimensions of HRQoL-physical, psychosocial, and pain-comparable to gender differences on the observed MCS and PCS scores. Gender differences are partly explained by sociodemographic and SES factors, highlighting the role of socioeconomic inequalities in perpetuating gender differences in health outcomes across multiple domains. These results also emphasize the importance of accounting for measurement invariance for meaningful comparison of group differences in estimated means of self-reported measures of health.
本研究旨在探讨健康相关生命质量（HRQoL）的综合评定在性别间的差异是否归因于健康特定维度的差异，以及这些差异是否可以通过社会人口统计学和社会经济状况（SES）的变化来解释。
国家健康测量研究收集了横断面数据，涉及 3648 名年龄在 35 至 89 岁的黑人和白人非住院成年人的全国样本。数据包括简明健康调查量表 36 项（Short Form 36-Item survey），该量表分别产生了心理健康和生理健康两个综合评分（Mental and Physical Component Summary scores，MCS 和 PCS），以及五个 HRQoL 指数：短表 6 维度（Short Form 6 dimension）、欧洲五维健康量表（EuroQol 5 dimension）、健康效用指数标记 2 版和 3 版（Health Utilities Indexes Mark 2 and 3）和健康幸福感自评量表（Quality of Well-Being Scale Self-Administered form）。结构方程模型被用于探索五个指数的身体、心理社会和疼痛的潜在维度在性别间的差异，同时调整社会人口统计学和 SES 指标。回归模型中检验了观察到的 MCS 和 PCS 评分，以判断潜在结果的稳健性。
男性在身体、心理社会和疼痛的估计健康状况方面均优于女性，而在 MCS 和 PCS 评分上也有类似的趋势。调整婚姻状况或收入比调整其他指标更能减少性别差异。调整 HRQoL 属性的部分因子不变性的结果支持了性别差异的存在，但也表明这些差异受到与某些 HRQoL 属性在性别间相关方式不同的维度的影响。
男性在 HRQoL 的三个潜在维度（身体、心理社会和疼痛）上的健康估计优于 MCS 和 PCS 评分上的性别差异。性别差异部分可以通过社会人口统计学和 SES 因素来解释，这突显了社会经济不平等在多个领域对健康结果性别差异的持续存在所起的作用。这些结果还强调了在有意义地比较自我报告健康测量的组间估计均值时，考虑测量不变性的重要性。
