Ota Hiromi
Department of Graduate School of Health Sciences, Kyorin University, Tokyo, Japan Public health Nursing, Department of Nursing, Faculty of Health Sciences, Kyorin University.
Nihon Koshu Eisei Zasshi. 2014;61(2):71-85. doi: 10.11236/jph.61.2_71.
Recent studies have investigated the relationship between social capital and health, although relatively few studies have evaluated the role of gender in this relationship. This study's aim was to investigate whether individual-level social capital in communities is associated with the self-reported health (self-rated health and depression) of urban elderly women and men living at home, even after adjusting for some confounding factors, and whether there is a gender difference in the association between social capital and health.
A self-administered questionnaire was mailed to 2,400 people aged between 65 and 79 who were not receiving long-term care insurance services in City A (Tokyo). Indicators of social capital, as represented by cognitive social capital (trust in neighbors and reciprocity) and structural social capital (group membership in local associations), were tested with two self-reported health indicators: perceived health and depression. The associations between social capital and perceptions of health were analyzed for men and women respectively using multivariate logistic regression analysis with adjustments made for age, economic status, educational status, presence of chronic disorders, functional capability levels, marital status, and duration of residence.
The number of valid responses was 1,776 (men: n=887, 71.2 ± 4.0 years; women: n=889, 70.9 ± 3.9 years; mean ± SD) with a response rate of 74.5%. Lower levels of cognitive social capital (civic mistrust) were associated with an odds ratio for poorer self-rated health of 1.58 (95% CI [1.07-2.34], P=.022) at the individual level in men. In women, lack of reciprocity (OR=1.63, 95% CI [1.10-2.41], P=.014) was associated with poorer self-rated health. Civic mistrust and lack of reciprocity were associated with depression in men and women. Lack of group membership in local associations was associated with self-rated health (OR=1.68, 95% CI [1.16-2.44], P=.007) and depression (OR=2.24, 95% CI [1.49-3.38], P<.001) in women.
Civic mistrust was associated with poorer self-rated health and a lack of reciprocity was associated with depression in men. In women, lack of reciprocity was associated with poorer self-rated health and depression, and lack of group membership in local associations was associated with self-rated health and depression. These results lead to the conclusion that there were noticeable gender differences in the relationship between the social capital and self-rated health of the elderly. A longitudinal study should be conducted to clarify the causal relationship between social capital and perceived health.
近期研究探讨了社会资本与健康之间的关系，不过相对较少的研究评估了性别在这一关系中的作用。本研究旨在调查社区层面的个体社会资本是否与居家城市老年男性和女性自我报告的健康状况（自评健康和抑郁）相关，即使在调整了一些混杂因素之后，以及社会资本与健康之间的关联是否存在性别差异。
向东京A市2400名年龄在65至79岁且未接受长期护理保险服务的人群邮寄了一份自填式问卷。用认知社会资本（对邻居的信任和互惠）和结构社会资本（当地协会的团体成员身份）来代表社会资本指标，并通过两个自我报告的健康指标进行测试：感知健康和抑郁。分别对男性和女性使用多元逻辑回归分析，分析社会资本与健康认知之间的关联，并对年龄、经济状况、教育状况、慢性病的存在、功能能力水平、婚姻状况和居住时长进行了调整。
有效回复数量为1776份（男性：n = 887，71.2 ± 4.0岁；女性：n = 889，70.9 ± 3.9岁；均值 ± 标准差），回复率为74.5%。在男性个体层面，较低水平的认知社会资本（公民不信任）与自评健康较差的优势比为1.58（95%置信区间[1.07 - 2.34]，P = 0.022）相关。在女性中，缺乏互惠（优势比 = 1.63，95%置信区间[1.10 - 2.41]，P = 0.014）与自评健康较差相关。公民不信任和缺乏互惠与男性和女性的抑郁均相关。在女性中，缺乏当地协会的团体成员身份与自评健康（优势比 = 1.68，95%置信区间[1.16 - 2.44]，P = 0.007）和抑郁（优势比 = 2.24，95%置信区间[1.49 - 3.38]，P < 0.001）相关。
公民不信任与男性自评健康较差相关，缺乏互惠与男性抑郁相关。在女性中，缺乏互惠与自评健康较差和抑郁相关，缺乏当地协会的团体成员身份与自评健康和抑郁相关。这些结果得出结论，老年人社会资本与自评健康之间的关系存在显著的性别差异。应开展纵向研究以阐明社会资本与感知健康之间的因果关系。
