Hoebel J, Kuntz B, Müters S, Lampert T
Robert Koch-Institut, Abteilung für Epidemiologie und Gesundheitsberichterstattung, Berlin.
Gesundheitswesen. 2013 Oct;75(10):643-51. doi: 10.1055/s-0032-1333211. Epub 2013 Mar 19.
The impact of subjective perception of social status on health has been analysed in international health research for several years. However, in Germany the empirical analysis of the relation between subjective social status (SSS) and health is still in the very early stages. This study investigates if health-related quality of life (HRQoL) in German adults is associated with SSS over and above conventional measures of social status.
The results are based on the German General Social Survey (ALLBUS 2010), a representative cross-sectional survey of the adult resident population in Germany (n=2 827). HRQoL was assessed with 4 items referring to self-rated health (SRH) and impairment of well-being due to bodily pain, depressiveness, and loneliness. SSS was measured with a 10-point scale where participants rated their status in society. The impact of SSS on HRQoL was analysed separately for men and women using logistic regression models adjusted for age, school education, net equivalent household income, and occupational position.
Poorer SRH, bodily pain, depressiveness, and loneliness occurred significantly more often in men and women with low SSS compared to those with higher SSS. After adjusting for age, education, income, and occupation, the effects of SSS on SRH and depressiveness remained significant in men and women (SRH: men: OR=4.76; 95% CI=2.52-8.99; women: OR=2.95; 95% CI=1.74-4.99; depressiveness: men: OR=2.86; 95% CI=1.60-5.10; women: OR=2.75; 95% CI=1.65-4.56). The effects of SSS on bodily pain and loneliness were observed only in women after adjustment for objective status indicators (OR=1.75; 95% CI=1.07-2.86 and OR=3.03; 95% CI=1.43-6.42, respectively).
These findings indicate that self-perception of social disadvantage affects HRQoL in German adults independently and partly gender-specifically. Hence, complementary to objective status indicators the SSS offers additional potential for describing and explaining health inequalities.
社会地位的主观认知对健康的影响在国际健康研究中已分析多年。然而，在德国，主观社会地位（SSS）与健康关系的实证分析仍处于非常早期的阶段。本研究调查德国成年人中与健康相关的生活质量（HRQoL）是否除了传统社会地位指标外还与SSS相关。
研究结果基于德国社会综合调查（ALLBUS 2010），这是一项对德国成年常住人口的代表性横断面调查（n = 2827）。HRQoL通过4个项目进行评估，涉及自评健康（SRH）以及因身体疼痛、抑郁和孤独导致的幸福感受损情况。SSS采用10分制量表进行测量，参与者对自己在社会中的地位进行评分。使用经年龄、学校教育、家庭净等效收入和职业地位调整的逻辑回归模型，分别分析SSS对男性和女性HRQoL的影响。
与高SSS的男性和女性相比，低SSS的男性和女性中，较差的SRH、身体疼痛、抑郁和孤独出现的频率显著更高。在调整年龄、教育、收入和职业后，SSS对男性和女性的SRH和抑郁的影响仍然显著（SRH：男性：OR = 4.76；95%CI = 2.52 - 8.99；女性：OR = 2.95；95%CI = 1.74 - 4.99；抑郁：男性：OR = 2.86；95%CI = 1.60 - 5.10；女性：OR = 2.75；95%CI = 1.65 - 4.56）。在调整客观地位指标后，仅在女性中观察到SSS对身体疼痛和孤独的影响（OR分别为1.75；95%CI = 1.07 - 2.86和OR = 3.03；95%CI = 1.43 - 6.42）。
这些发现表明，社会劣势的自我认知独立且部分因性别而异地影响德国成年人的HRQoL。因此，除了客观地位指标外，SSS为描述和解释健康不平等提供了额外的潜力。
