Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
Soc Sci Med. 2012 Jun;74(12):1921-8. doi: 10.1016/j.socscimed.2012.02.015. Epub 2012 Mar 21.
This paper examines associations between three indicators of socioeconomic status, education, income and bank savings, as well as one composite of these three measures, and self-assessed health for adults aged 50+ across rural and urban Thailand, comparing 1994 and 2007. Between 1994 and 2007 Thailand experienced rapid social changes that could impact on health overall and across groups, including population aging, socioeconomic development and changes in health policy. This led us to test whether overall health has improved as a result and whether the SES health gradient has changed. The data come from comparable survey sources from over seventy-thousand respondents, collected by Thailand's National Statistical Office. Generalized proportional ordered logit models were run that include up to three-way interactions of SES by year by rural versus urban location of residence are run. The three-way interactions allow for testing and of whether changes over time are due to complex intertwined effects. Results indicate that a) there has been improvement in health among the population aged 50 years and older in Thailand; b) there has been a flattening in the SES - health gradient in rural areas, and c) there has been little change in the gradient in urban areas, and if anything, there has been a widening of the relationship between income and health in urban Thailand. Divergence in the way the gradient has changed across rural and urban Thailand may point to the impact of social policy that has been aimed at poorer rural residents.
本文考察了社会经济地位的三个指标——教育、收入和银行储蓄，以及这三个指标的综合指标，与泰国城乡 50 岁以上成年人的自评健康之间的关系，并对 1994 年和 2007 年的数据进行了比较。在 1994 年至 2007 年期间，泰国经历了快速的社会变革，这些变革可能会对整体健康和不同群体的健康产生影响，包括人口老龄化、社会经济发展和卫生政策的变化。这使我们检验了整体健康状况是否因此得到改善，以及 SES 健康梯度是否发生了变化。数据来自泰国国家统计局从超过 7 万名受访者中收集的可比调查来源。我们运行了广义比例有序逻辑回归模型，其中包括 SES 与年份以及城乡居住地点之间的三向交互作用。三向交互作用允许测试和检验时间变化是否是由于复杂的相互交织的影响。结果表明：a）泰国 50 岁及以上人口的健康状况有所改善；b）农村地区 SES 与健康梯度趋于平坦；c）城市地区梯度变化不大，如果有的话，泰国城市地区收入与健康之间的关系有所扩大。农村和城市地区梯度变化方式的差异可能表明，旨在帮助农村贫困居民的社会政策产生了影响。
