Drożdżak Zuzanna, Turek Konrad
Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Int J Equity Health. 2016 Feb 4;15:21. doi: 10.1186/s12939-016-0310-3.
Identifying mechanisms that generate and sustain health inequalities is a prerequisite for developing effective policy response, but little is known about factors contributing to health inequalities in older populations in post-transitional European countries such as Poland. Demographic aging of all populations requires new and deeper insights.
Data came from the Polish edition of the cross-sectional European Social Survey, Wave 6 (2012). Logistic regression was applied to identify socioeconomic factors relevant to self-assessed health in a population aged 45 or over. Decomposition of a concentration index provided information about the distribution of health-relevant demographics and social characteristics along a socioeconomic continuum, and their contributions to observed health inequalities.
Overall, 17.4 % of respondents aged 45 or over assessed their health as poor or very poor. Predictors of poor health included income insufficiency, disability or retirement, retirement, low social activity, and social position. A steep socioeconomic gradient in self-assessed health in Polish population was found. The primary contributor to the observed health inequality (as summarized by concentration index) was income, followed by labor market situation, particularly retirement. Self-assessed place in society contributed to overall inequality, scoring similarly to social activity. Contributions from age and education were moderate but non-significant, gender was negligible, and chronological aging explained neither poor health nor socioeconomic health inequalities.
Although elderly people represent a particularly vulnerable group, their disadvantages are associated with social rather than natural causes. Policies addressing health inequalities in aging populations must provide systemic opportunities for maintaining good health. Transitioning to retirement is a critical entry point for policy action that stimulates social engagement and maintains self-esteem of older people.
识别产生和维持健康不平等的机制是制定有效政策应对措施的前提条件，但对于像波兰这样的后转型欧洲国家老年人口健康不平等的影响因素却知之甚少。所有人口的老龄化都需要新的、更深入的见解。
数据来自欧洲社会调查波兰版第六轮（2012年）的横断面调查。应用逻辑回归来确定45岁及以上人群中与自我评估健康相关的社会经济因素。集中指数分解提供了有关与健康相关的人口统计学和社会特征沿社会经济连续体的分布信息，以及它们对观察到的健康不平等的贡献。
总体而言，45岁及以上的受访者中有17.4%将自己的健康状况评为差或非常差。健康状况差的预测因素包括收入不足、残疾或退休、退休、社交活动少和社会地位。在波兰人口中，自我评估健康方面发现了明显的社会经济梯度。观察到的健康不平等（由集中指数总结）的主要促成因素是收入，其次是劳动力市场状况，特别是退休。自我评估的社会地位对总体不平等有贡献，得分与社交活动相似。年龄和教育的贡献适中但不显著，性别可忽略不计，按时间顺序的衰老既不能解释健康状况差，也不能解释社会经济健康不平等。
尽管老年人是特别脆弱的群体，但他们的劣势与社会而非自然原因有关。解决老年人口健康不平等问题的政策必须提供维持良好健康的系统性机会。向退休过渡是政策行动的关键切入点，可促进社会参与并维护老年人的自尊。
