Ezeamama A E, Guwatudde D, Wang M, Bagenda D, Brown K, Kyeyune R, Smith Emily, Wamani H, Manabe Y C, Fawzi W W
Department of Epidemiology and Biostatistics, The University of Georgia, B.S. Miller Hall Room 125, 101 Buck Rd, Athens, GA, 30602, USA.
School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
J Behav Med. 2016 Jun;39(3):453-64. doi: 10.1007/s10865-015-9710-x. Epub 2016 Jan 5.
Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.
采用横断面研究设计，对来自坎帕拉的乌干达成年HIV感染者的健康结果差异的决定因素进行了感知社会地位（PSS）评估。PSS采用经翻译和改编以适应该研究环境的麦克阿瑟主观社会地位量表进行定义。使用线性回归模型确定入组时PSS排名的社会人口统计学和心理社会相关因素。基于PSS得分中位数定义高PSS和低PSS，并通过线性回归评估其作为体重指数、血红蛋白、生活质量（QOL）和虚弱相关表型的决定因素。对数二项回归模型估计了与PSS相关的良好、非常好或优秀与一般或较差自评健康（SRH）的相对风险。年龄较大、社会支持增加和物质财富与高PSS排名相关，而女性、多重耻辱经历和多重抑郁症状与低PSS排名相关。与低PSS患者相比，高PSS参与者平均体重重1.1kg/m²，虚弱得分低4.7%，QOL得分高3.6%（所有p<0.05）；他们也更有可能将自己归类为高SRH（相对风险1.4，95%置信区间1.1，1.7），但血红蛋白水平相当（p=0.634）。低PSS与乌干达HIV阳性成年人的身体和心理社会健康状况不佳相关。将PSS评估作为临床管理的一部分，同时努力减少耻辱感并改善社会支持，可能会识别并可能减少乌干达HIV成年患者中与PSS相关的健康不平等。
