Huijts Tim, Gkiouleka Anna, Reibling Nadine, Thomson Katie H, Eikemo Terje A, Bambra Clare
Department of Sociology, Wentworth College, University of York Heslington, York, UK.
University of Siegen, Siegen, Germany.
Eur J Public Health. 2017 Feb 1;27(suppl_1):63-72. doi: 10.1093/eurpub/ckw220.
It has been suggested that cross-national variation in educational inequalities in health outcomes (e.g. NCDs) is due to cross-national variation in risky health behaviour. In this paper we aim to use highly recent data (2014) to examine educational inequalities in risky health behaviour in 21 European countries from all regions of the continent to map cross-national variation in the extent to which educational level is associated with risky health behaviour. We focus on four dimensions of risky health behaviour: smoking, alcohol use, lack of physical activity and lack of fruit and vegetable consumption.
We make use of recent data from the 7th wave of the European Social Survey (2014), which contains a special rotating module on the social determinants of health. We performed logistic regression analyses to examine the associations between educational level and the risky health behaviour indicators. Educational level was measured through a three-category version of the harmonized International Standard Classification of Education (ISCED).
Our findings show substantial and mostly significant inequalities in risky health behaviour between educational groups in most of the 21 European countries examined in this paper. The risk of being a daily smoker is higher as respondents’ level of education is lower (Low education (L): OR = 4.24 (95% CI: 3.83–4.68); Middle education (M): OR = 2.91 (95% CI: 2.65–3.19)). Respondents have a lower risk of consuming alcohol frequently if they have a low level of education (L: OR = 0.59 (95% CI: 0.54–0.64); M: OR = 0.70 (95% CI: 0.65–0.76)), but a higher risk of binge drinking frequently (L: OR = 1.29 (95% CI: 1.16–1.44); M: OR = 1.15 (95% CI: 1.04–1.27)). People are more likely to be physically active at least 3 days in the past week when they have a higher level of education (M: OR = 1.42 (95% CI: 1.34–1.50); H: OR = 1.67 (95% CI: 1.55–1.80)). Finally, people are more likely to consume fruit and vegetables at least daily if they have a higher level of education (fruit: M: OR = 1.09 (95% CI: 1.03–1.16); H: OR = 1.77 (95% CI: 1.63–1.92); vegetables: M: OR = 1.34 (95% CI: 1.26–1.42); H: OR = 2.35 (95% CI: 2.16–2.55)). However, we also found considerable cross-national variation in the associations between education and risky health behaviour.
Our results yield a complex picture: the lowest educational groups are more likely to smoke and less likely to engage in physical activity and to eat fruit and vegetables, but the highest educational groups are at greater risk of frequent alcohol consumption. Additionally, inequalities in risky health behaviour do not appear to be systematically weakest in the South or strongest in the North and West of Europe.
有人认为，健康结果（如非传染性疾病）方面教育不平等的跨国差异是由于危险健康行为的跨国差异所致。在本文中，我们旨在利用最新数据（2014年）来研究欧洲大陆所有地区21个欧洲国家危险健康行为中的教育不平等情况，以描绘教育水平与危险健康行为之间关联程度的跨国差异。我们关注危险健康行为的四个维度：吸烟、饮酒、缺乏体育活动以及水果和蔬菜摄入量不足。
我们利用了欧洲社会调查第7轮（2014年）的最新数据，该数据包含一个关于健康社会决定因素的特殊轮换模块。我们进行了逻辑回归分析，以研究教育水平与危险健康行为指标之间的关联。教育水平通过统一的国际教育标准分类（ISCED）的三级版本来衡量。
我们的研究结果表明，在本文所研究的21个欧洲国家中的大多数国家，不同教育群体在危险健康行为方面存在显著且大多具有统计学意义的不平等。随着受访者教育水平的降低，每日吸烟的风险更高（低教育水平（L）：比值比（OR）=4.24（95%置信区间：3.83 - 4.68）；中等教育水平（M）：OR = 2.91（95%置信区间：2.65 - 3.19））。教育水平低的受访者频繁饮酒的风险较低（L：OR = 0.59（95%置信区间：0.54 - 0.64）；M：OR = 0.70（95%置信区间：0.65 - 0.76）），但频繁暴饮的风险较高（L：OR = 1.29（95%置信区间：1.16 - 1.44）；M：OR = 1.15（95%置信区间：1.04 - 1.27））。教育水平较高的人在过去一周中至少有3天进行体育活动的可能性更大（M：OR = 1.42（95%置信区间：1.34 - 1.50）；高教育水平（H）：OR = 1.67（95%置信区间：1.55 - 1.80））。最后，教育水平较高的人每天至少食用水果和蔬菜的可能性更大（水果：M：OR = 1.09（95%置信区间：1.03 - 1.16）；H：OR = 1.77（95%置信区间：1.63 - 1.92）；蔬菜：M：OR = 1.34（95%置信区间：1.26 - 1.42）；H：OR = 2.35（95%置信区间：2.16 - 2.55））。然而，我们也发现教育与危险健康行为之间的关联存在相当大的跨国差异。
我们的研究结果呈现出一幅复杂的图景：教育水平最低的群体吸烟的可能性更大，进行体育活动以及食用水果和蔬菜的可能性更小，但教育水平最高的群体频繁饮酒的风险更高。此外，危险健康行为方面的不平等在欧洲南部似乎并非系统性地最弱，在欧洲北部和西部也并非最强。
