Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America ; Geriatric Research, Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina, United States of America.
PLoS One. 2013 Sep 13;8(9):e73930. doi: 10.1371/journal.pone.0073930. eCollection 2013.
In high income, developed countries, health status tends to improve as income increases, but primarily through the 50(th)-66(th) percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions.
Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥ 60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures.
In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes.
Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled.
在高收入发达国家，健康状况往往随着收入的增加而改善，但主要是在收入的 50%至 66%之间。目前尚不清楚这种局限性是否存在于中等收入国家，以及对一般健康评估和特定疾病状况是否存在。
数据来自中等收入国家巴西。在南里奥格兰德州进行了一项针对≥60 岁社区居民的代表性样本的面对面访谈（N=6963），调查了包括家庭收入和供养人数、一般健康状况（自我评估健康、功能状态）、抑郁以及 7 种医生诊断的、自我报告的健康状况在内的人口特征信息。分析采用家庭收入（根据供养人数和规模经济进行调整）以及更高阶的收入项，控制了人口统计学和合并症，以确定收入与一般和特定健康指标之间的非线性关系。
在完全控制的分析中，收入与一般健康指标相关（与自我评估健康呈线性关系，与功能状态呈非线性关系）。对于特定的健康指标，与抑郁、肺部疾病、肾脏疾病和感觉障碍呈一致的线性关联。对于肌肉骨骼、心血管（负相关）和胃肠道疾病，当控制合并症时，这种关联不再成立。与糖尿病无关。
与高收入国家的发现相反，家庭规模调整后的收入与健康的关联通常是线性的，有时是负相关的，有时在控制合并症时则不存在。
