Janzen Bonnie, Karunanayake Chandima, Pahwa Punam, Dyck Roland, Rennie Donna, Lawson Josh, Pickett William, Bryce Rhonda, Hagel Louise, Zhao Guangming, Dosman James
Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
J Rural Health. 2015 Spring;31(2):186-98. doi: 10.1111/jrh.12101. Epub 2014 Dec 24.
To describe the patterning of socioeconomic inequalities in health among rural dwelling women and men in a Canadian province, exploring diversity in associations by measure of socioeconomic position, health outcome, and demographic characteristics.
Baseline data from the Saskatchewan Rural Health Study was used, an ongoing prospective cohort study examining the health of rural people in Saskatchewan, Canada. Of the 11,004 eligible addresses, responses to mailed questionnaires were obtained from 4,624 (42%) households, representing 8,261 women and men. Multiple logistic regression was the primary method of analysis; generalized estimating equations were utilized to account for household clustering. Associations between 5 health outcomes (self-rated health, chronic obstructive lung disease, diabetes, heart attack, high blood pressure) and 4 indicators of socioeconomic position (income, education, financial strain, occupational skill level) were assessed, with age and gender as potential effect modifiers.
With the exception of occupational skill level, socioeconomic position (SEP) indicators were strongly and inversely related to most health outcomes, often in a graded manner. Associations between SEP and several health outcomes were weaker for older than younger participants (heart attack, high blood pressure, lung disease) and stronger among women compared to men (high blood pressure, lung disease).
The patterning of SEP-health associations observed in this rural Canadian sample suggests the need for health promotion strategies and policy initiatives to be broadly targeted at individuals and families occupying a wide range of socioeconomic circumstances.
描述加拿大一个省份农村居民中男女健康方面社会经济不平等的模式，通过社会经济地位、健康结果和人口特征的衡量标准来探索关联的多样性。
使用了萨斯喀彻温农村健康研究的基线数据，这是一项正在进行的前瞻性队列研究，旨在考察加拿大萨斯喀彻温农村居民的健康状况。在11,004个符合条件的地址中，从4,624户（42%）家庭获得了对邮寄问卷的回复，代表8,261名男女。多因素逻辑回归是主要分析方法；采用广义估计方程来考虑家庭聚类情况。评估了5种健康结果（自评健康、慢性阻塞性肺病、糖尿病、心脏病发作、高血压）与4种社会经济地位指标（收入、教育、经济压力、职业技能水平）之间的关联，并将年龄和性别作为潜在的效应修饰因素。
除职业技能水平外，社会经济地位（SEP）指标与大多数健康结果呈强烈的负相关，且往往呈梯度关系。SEP与几种健康结果之间的关联在老年参与者中比年轻参与者中更弱（心脏病发作、高血压、肺病），在女性中比男性中更强（高血压、肺病）。
在这个加拿大农村样本中观察到的SEP与健康的关联模式表明，需要制定健康促进策略和政策举措，广泛针对处于各种社会经济状况的个人和家庭。
