Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.
Public Health. 2016 Dec;141:32-41. doi: 10.1016/j.puhe.2016.08.005. Epub 2016 Sep 16.
The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years.
This study is based on a population-based, cross-sectional survey.
We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality.
About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH -0.122 (95% CI: -0.102; -0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health.
Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians.
本研究旨在衡量自我报告健康状况（SRH）和医疗保健就诊方面的社会经济不平等，并确定导致 50 岁以上老年人健康不平等的因素。
本研究基于一项基于人群的横断面调查。
我们从世界卫生组织全球老龄化和成人健康印度调查中获取了 7150 名老年人的数据。我们使用多变量逻辑回归来评估 SRH 不良的相关因素。我们估计集中指数来衡量 SRH 和医疗保健就诊方面的社会经济不平等。回归分解分析用于探讨导致 SRH 不平等的相关因素。
约 19%（95%CI：18%，20%）报告健康状况不佳（n=1368），这些人明显较不富裕。共有 5134 名（71.8%）参与者至少进行了一次医疗服务就诊。年龄增长、女性性别、社会地位低、农村居住、多种疾病、无养老金支持和医疗保险是 SRH 不良的显著相关因素。SRH 不良的标准化集中指数为-0.122（95%CI：-0.102；-0.141），医疗保健就诊的集中指数为 0.364（95%CI：0.324，0.403），表明存在有利于贫困者和有利于富裕者的不平等。经济状况（62.3%）、养老金支持（11.5%）、医疗保险覆盖（11.5%）、社会地位（10.7%）和居住地（4.1%）是导致印度老年人健康不平等的重要因素。
印度在健康和医疗保健方面存在社会经济不平等，这是一个主要问题。要实现健康公平，需要采取超越卫生政策的扶贫、社会福利政策，以满足印度老年人的需求。
