哈萨克斯坦阿拉木图45岁及以上人群自评健康状况的不平等：一项横断面研究。
Inequalities in self-rated health among 45+ year-olds in Almaty, Kazakhstan: a cross-sectional study.
作者信息
Abikulova Akmaral K, Tulebaev Kazbek A, Akanov Aikan A, Turdalieva Botagoz S, Kalmahanov Sundetgali B, Kumar Ainur B, Izekenova Aigulsum K, Mussaeva Bakhyt A, Grjibovski Andrej M
机构信息
International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
出版信息
BMC Public Health. 2013 Jul 15;13:654. doi: 10.1186/1471-2458-13-654.
BACKGROUND
Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan.
METHODS
Altogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and socio-demographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI).
RESULTS
Altogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and self-reported material deprivation in both crude and adjusted analyses. Women were more likely to report poor (OR=1.9, 95% CI: 1.2-3.1) or satisfactory (OR=1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR=2.3, 95% CI: 1.5-3.7 and OR=4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR=1.4, 95% CI: 1.1-1.9 and OR=1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between white- and blue-collar workers.
CONCLUSION
Considerable levels of inequalities in SRH by age, gender, education and particularly self-reported material deprivation, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan.
背景
在发达国家和发展中国家，自评健康状况（SRH）已被广泛用于评估健康不平等情况。然而，中亚地区尚未开展此类研究。本研究旨在评估哈萨克斯坦阿拉木图市在SRH方面的性别、种族和社会不平等情况。
方法
总共邀请了1500名随机选取的45岁及以上成年人参与一项横断面研究，其中1199人同意参与（应答率80%）。SRH被分为差、满意、良好和优秀。采用多项逻辑回归分析来研究SRH与社会人口学特征之间的关联。计算了健康状况差与良好以及满意与良好之间的粗比值比（OR）和调整后比值比，并给出95%置信区间（CI）。
结果
应答者中，分别有11.8%、53.7%、31.0%和3.2%的人报告健康状况差、满意、良好和优秀。在粗分析和调整分析中，按年龄、教育程度和自我报告的物质匮乏程度观察到SRH存在明显梯度。女性报告健康状况差（OR = 1.9，95% CI：1.2 - 3.1）或满意（OR = 1.6，95% CI：1.2 - 2.1）的可能性高于良好。在粗分析中，俄罗斯族和未婚参与者健康状况差与良好相比（OR分别为2.3，95% CI：1.5 - 3.7和OR = 4.0，95% CI：2.7 - 6.1）以及满意与良好相比（OR分别为1.4，95% CI：1.1 - 1.9和OR = 1.9，95% CI：1.4 - 2.5）的比值比更高，但调整后估计值降至无统计学意义水平。失业者和退休人员报告健康良好的可能性低于白领，而白领和蓝领在SRH方面未观察到差异。
结论
在哈萨克斯坦阿拉木图市，发现SRH在年龄、性别、教育程度尤其是自我报告的物质匮乏程度方面存在相当程度的不平等，但在种族或婚姻状况方面不存在不平等。有必要进一步开展研究以确定哈萨克斯坦所观察到的关联背后的因素。
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