Kaczmarek M, Pacholska-Bogalska J, Kwaśniewski W, Kotarski J, Halerz-Nowakowska B, Goździcka-Józefiak A
Department of Human Biological Development, Institute of Anthropology, Faculty of Biology, Adam Mickiewicz University in Poznań, Poland.
Department of Animal Physiology, Institute of Experimental Biology, Faculty of Biology, Adam Mickiewicz University in Poznań, Poland.
Homo. 2017 Jan;68(1):42-50. doi: 10.1016/j.jchb.2016.11.004. Epub 2016 Dec 1.
In recent years, more scholarly attention has been paid to a growing range of geographic characteristics as antecedents of inequalities in women's health and well-being. The purpose of this study was to evaluate differences in health-related quality of life between rural and urban Polish postmenopausal women. Using a data set from a reproductive health preventive screening of 660 postmenopausal women aged 48-60 years, inhabitants of Wielkopolska and Lublin provinces, the association of place of residence, socioeconomic status and lifestyle factors with health-related quality of life (the SF-36 instrument) was evaluated using ANCOVA models and multiple logistic regression analysis with backward elimination steps. A consistent rural-to-urban gradient was found in all indices of physical health functioning and well-being but not in vitality, social functioning, emotional role and mental health scales with women in large cities being likely to enjoy the highest and those in villages the lowest quality of life. The rural-urban disparities in health-related quality of life were mediated by women's socioeconomic status. The likelihood of worse physical and mental functioning and well-being was 2-3 times greater for the low socioeconomic status rural women than their counterparts from more affluent urban areas. The educational attainment and employment status were the most powerful independent risk factors for health-related quality of life in both rural and urban women. Better understanding of the role of socioeconomic status that acts as a mediator in the association between area of residence and health-related quality of life may be useful in developing public health policies on health inequalities among women at midlife.
近年来，越来越多的学术关注集中在一系列日益增多的地理特征上，这些特征被视为女性健康与福祉不平等的先行因素。本研究的目的是评估波兰城乡绝经后女性在健康相关生活质量方面的差异。利用来自大波兰省和卢布林省660名年龄在48 - 60岁绝经后女性的生殖健康预防性筛查数据集，使用协方差分析模型以及带有向后消除步骤的多元逻辑回归分析，评估居住地点、社会经济地位和生活方式因素与健康相关生活质量（SF - 36量表）之间的关联。在身体健康功能和福祉的所有指标中都发现了从农村到城市的一致梯度，但在活力、社会功能、情感角色和心理健康量表方面并非如此，大城市的女性生活质量可能最高，而农村女性的生活质量最低。健康相关生活质量的城乡差异由女性的社会经济地位介导。社会经济地位低的农村女性在身体和心理功能及福祉方面较差的可能性是来自更富裕城市地区女性的2至3倍。教育程度和就业状况是城乡女性健康相关生活质量最有力的独立风险因素。更好地理解社会经济地位在居住地区与健康相关生活质量之间的关联中所起的中介作用，可能有助于制定关于中年女性健康不平等问题的公共卫生政策。
