INSERM-UMR1027, Toulouse, France.
BMC Public Health. 2012 Jan 10;12:19. doi: 10.1186/1471-2458-12-19.
Self-rated Health (SRH) and health-related quality of life (HRQoL) are used to evaluate health disparities. Like all subjective measures of health, they are dependent on health expectations that are associated with socioeconomic characteristics. It is thus needed to analyse the influence played by socioeconomic position (SEP) on the relationship between these two indicators and health conditions if we aim to use them to study health disparities. Our objective is to assess the influence of SEP on the relationship between physical health status and subjective health status, measured by SRH and HRQoL using the SF-36 scale.
We used data from the French National Health Survey. SEP was assessed by years of education and household annual income. Physical health status was measured by functional limitations and chronic low back pain.
Regardless of their health status, people with lower SEP were more likely than their more socially advantaged counterparts to report poor SRH and poorer HRQoL, using any of the indicators of SEP. The negative impact of chronic low back pain on SRH was relatively greater in people with a high SEP than in those with a low SEP. In contrast, chronic low back pain and functional limitations had less impact on physical and mental component scores of quality of life for socially advantaged men and women.
Both SRH and HRQoL were lower among those reporting functional limitations or chronic low back pain. However, the change varied according SEP and the measure. In relative term, the negative impact of a given health condition seems to be greater on SRH and lower on HRQoL for people with higher SEP in comparison with people with low SEP. Using SRH could thus decrease socioeconomic differences. In contrast using HRQoL could increase these differences, suggesting being cautious when using these indicators for analyzing health disparities.
自评健康 (SRH) 和健康相关生活质量 (HRQoL) 用于评估健康差异。与所有主观健康衡量标准一样，它们取决于与社会经济特征相关的健康预期。因此，如果我们旨在使用这些指标来研究健康差异，就需要分析社会经济地位 (SEP) 对这两个指标与健康状况之间关系的影响。我们的目的是评估 SEP 对身体健康状况和主观健康状况（通过 SRH 和 HRQoL 使用 SF-36 量表测量）之间关系的影响。
我们使用了法国国家健康调查的数据。SEP 通过受教育年限和家庭年收入来评估。身体健康状况通过功能限制和慢性腰痛来衡量。
无论健康状况如何，社会经济地位较低的人比社会地位较高的人更有可能报告自评健康状况较差和 HRQoL 较差，无论使用哪种 SEP 指标。慢性腰痛对高 SEP 人群的 SRH 影响比对低 SEP 人群的影响更大。相比之下，慢性腰痛和功能限制对社会地位较高的男性和女性的身体和心理成分得分的生活质量的影响较小。
报告有功能限制或慢性腰痛的人自评健康状况和 HRQoL 均较低。然而，变化根据 SEP 和测量方法而有所不同。在相对术语中，与社会经济地位较低的人相比，社会经济地位较高的人给定健康状况的负面影响在 SRH 上更大，在 HRQoL 上较小。因此，使用 SRH 可能会减少社会经济差异。相反，使用 HRQoL 可能会增加这些差异，这表明在分析健康差异时使用这些指标要谨慎。
