Platts Loretta G, Gerry Christopher J
Stress Research Institute, Stockholm University, Stockholm, Sweden.
International Centre for Health Economics, Management, and Policy, National Research University Higher School of Economics, Saint Petersburg, Russian Federation.
Eur J Public Health. 2017 Apr 1;27(2):211-217. doi: 10.1093/eurpub/ckw143.
Despite Ukraine's large population, few studies have examined social inequalities in health. This study describes Ukrainian educational inequalities in self-rated health and assesses how far psychosocial, material and behavioural factors account for the education gradient in health.
Data were analyzed from the 2007 wave of the Ukrainian Longitudinal Monitoring Survey. Education was categorized as: lower secondary or less, upper secondary and tertiary. In logistic regressions of 5451 complete cases, stratified by gender, declaring less than average health was regressed on education, before and after adjusting for psychosocial, material and behavioural factors.
In analyses adjusted for socio-demographic characteristics, compared with those educated up to lower secondary level, tertiary education was associated with lower risk of less than average health for both men and women. Including material factors (income quintiles, housing assets, labour market status) reduced the association between education and health by 55-64% in men and 35-47% in women. Inclusion of health behaviours (physical activity, smoking, alcohol consumption and body mass index) reduced the associations by 27-30% in men and 19-27% in women; in most cases including psychosocial factors (marital status, living alone, trust in family and friends) did not reduce the size of the associations. Including all potential explanatory factors reduced the associations by 68-84% in men and 43-60% in women.
The education gradient in self-rated health in Ukraine was partly accounted for by material and behavioural factors. In addition to health behaviours, policymakers should consider upstream determinants of health inequalities, such as joblessness and poverty.
尽管乌克兰人口众多，但很少有研究探讨健康方面的社会不平等问题。本研究描述了乌克兰自评健康方面的教育不平等情况，并评估心理社会、物质和行为因素在多大程度上解释了健康方面的教育梯度。
对乌克兰纵向监测调查2007年的数据进行分析。教育程度分为：初中及以下、高中和大专。在对5451个完整案例进行的逻辑回归分析中，按性别分层，在调整心理社会、物质和行为因素之前和之后，将自评健康状况低于平均水平的情况与教育程度进行回归分析。
在对社会人口学特征进行调整的分析中，与初中及以下学历的人相比，大专学历的男性和女性自评健康状况低于平均水平的风险较低。纳入物质因素（收入五分位数、住房资产、劳动力市场状况）后，男性教育与健康之间的关联降低了55% - 64%，女性降低了35% - 47%。纳入健康行为（体育活动、吸烟、饮酒和体重指数）后，男性的关联降低了27% - 30%，女性降低了19% - 27%；在大多数情况下，纳入心理社会因素（婚姻状况、独居、对家人和朋友的信任）并没有降低关联的幅度。纳入所有潜在解释因素后，男性的关联降低了68% - 84%，女性降低了43% - 60%。
乌克兰自评健康方面的教育梯度部分由物质和行为因素所致。除健康行为外，政策制定者还应考虑健康不平等的上游决定因素，如失业和贫困。
