Cambois Emmanuelle, Solé-Auró Aïda, Brønnum-Hansen Henrik, Egidi Viviana, Jagger Carol, Jeune Bernard, Nusselder Wilma J, Van Oyen Herman, White Chris, Robine Jean-Marie
Department of Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France.
Department of Political and Social Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
J Epidemiol Community Health. 2016 Apr;70(4):331-8. doi: 10.1136/jech-2015-205978. Epub 2015 Nov 6.
Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes.
Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups.
The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups.
The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.
所有欧洲国家都存在残疾患病率的社会差异，但其规模差异显著。为增进对这种差异的理解，本文聚焦于社会梯度的两端。它比较了低社会群体中较高残疾患病率的程度（称为残疾劣势）和高社会群体中较低患病率的程度（残疾优势）；并讨论了福利制度的可能影响下各国特有的优势/劣势。
通过2009年欧洲收入和生活条件统计（EU-SILC）中与长期健康相关的活动受限（AL）来衡量26个国家的横断面残疾患病率，这些国家分为四个福利制度组。经国家、年龄和性别调整的逻辑模型（涵盖所有30 - 79岁人群及三个年龄组）测量了各国教育程度的特定OR值，代表低教育群体的AL劣势和高教育群体相对于中等教育群体的AL优势。
瑞典（例如，1.2（1.0 - 1.4））、芬兰、罗马尼亚、保加利亚和西班牙（最年轻年龄组）中低教育群体的相对AL劣势较小，但在捷克共和国（例如，1.9（1.7 - 2.2））、丹麦、比利时、意大利和匈牙利则较大。高教育群体在丹麦有较小的相对AL优势（例如，0.9（0.8 - 1.1）），但在立陶宛有较大的AL优势（例如，0.5（0.4 - 0.6）），在波罗的海和东欧国家的一半、挪威和德国（最年轻年龄组）也是如此。福利制度组内部存在显著差异。
此处确定的各国教育群体特有的残疾优势/劣势有助于识别决定因素以及为解决健康方面的社会差异而实施的国家政策的效率。
