Anne L. F. van der Kooi, Caroline A. Thompson, Maral DerSarkissian, and Onyebuchi A. Arah are with the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles. Anne-Lotte van der Kooi and Onyebuchi A. Arah are also with and Karien Stronks is with the Department of Public Health, Academic Medical Center, University of Amsterdam, Netherlands.
Am J Public Health. 2013 Nov;103(11):e49-54. doi: 10.2105/AJPH.2013.301593. Epub 2013 Sep 12.
We investigated how much the Human Development Index (HDI), a global measure of development, modifies the effect of education on self-reported health.
We analyzed cross-sectional World Health Survey data on 217,642 individuals from 49 countries, collected in 2002 to 2005, with random-intercept multilevel linear regression models.
We observed greater positive associations between educational levels and self-reported good health with increasing HDI. The magnitude of this effect modification of the education-health relation tended to increase with educational attainment. For example, before adjustment for effect modification, at comparable HDI, on average, finishing primary school was associated with better general health (b = 1.49; 95% confidence interval [CI] = 1.18, 1.80). With adjustment for effect modification by HDI, the impact became 4.63 (95% CI = 3.63, 5.62) for every 0.1 increase in HDI. Among those who completed high school, these associations were, respectively, 5.59 (95% CI = 5.20, 5.98) and 9.95 (95% CI = 8.89, 11.00).
The health benefits of educational attainment are greater in countries with greater human development. Health inequalities attributable to education are, therefore, larger in more developed countries.
我们研究了人类发展指数（HDI），一种全球发展衡量标准，在多大程度上改变了教育对自我报告健康的影响。
我们分析了 2002 年至 2005 年期间来自 49 个国家的 217642 名个体的横断面世界卫生调查数据，采用随机截距多水平线性回归模型。
我们观察到，随着 HDI 的增加，教育水平与自我报告的良好健康状况之间的正相关关系更大。这种教育与健康关系的效应修饰的程度往往随着教育程度的提高而增加。例如，在没有调整效应修饰的情况下，在可比的 HDI 下，平均而言，完成小学教育与更好的总体健康状况相关（b = 1.49；95%置信区间[CI] = 1.18，1.80）。在调整了 HDI 的效应修饰后，HDI 每增加 0.1，影响变为 4.63（95%CI = 3.63，5.62）。在完成高中教育的人群中，这些关联分别为 5.59（95%CI = 5.20，5.98）和 9.95（95%CI = 8.89，11.00）。
教育程度带来的健康益处在人类发展程度较高的国家更大。因此，在较发达国家，教育导致的健康不平等更大。
