Volken T, Wieber F, Rüesch P, Huber M, Crawford R J
Institue for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.
Institue for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland; Department of Psychology, University of Konstanz, Konstanz, Germany.
Public Health. 2017 Sep;150:152-165. doi: 10.1016/j.puhe.2017.07.007. Epub 2017 Aug 10.
Our study aimed to describe the temporal changes in self-rated health status (SRH) from 1997 to 2012 in adults aged 25 to 84 residing in Switzerland, with a view to identifying groups at risk for declining health.
Secondary analysis of population-based cross-sectional health surveys.
Data were collected from the cross-sectional, population-based, five-year Swiss Health Survey, from 1997, 2002, 2007 and 2012. A total of 63,861 individuals' data were included. Multilevel mixed-effect logistic regression analysis was employed to estimate the probability of very good and good health within the framework of a hierarchical cross-classified age-period-cohort model (HAPC), adjusting for education level, gender, civil status, smoking status and body mass index.
Individuals with higher education were substantially more likely than those with primary education to report good SRH (OR = 2.12; 95% CI = 1.93-2.33 for secondary education and OR = 3.79; 95% CI = 3.39-4.23 for tertiary education). The education effect depended on birth cohort and age: higher proportions of good SRH were reported by secondary (8%-17%) and tertiary (10%-22%) compared with primary educated individuals from the 1940 birth cohort onward; the proportion of secondary/tertiary (compared to primary) educated people reporting good SRH increased with age (by 10/11% at 45-50 years and 25/36% at 80-84 years). Gender health equality was achieved by the 1955 (primary educated) and 1960 (secondary educated) birth cohorts, while these women overtook men in reporting good SRH from the 1975 birth cohort onward. Tertiary educated younger women were significantly less likely to report good SRH than men but parity was achieved at around pension age. Similarly, gender inequality in those with primary and secondary education reduced in the younger ages to not be significant at around age 55, with women overtaking men from age 65.
Younger birth cohorts with lower education levels appear most vulnerable in terms of their SRH. The education effect cumulatively increases when attaining incrementally higher education levels. While women report lower health than men, gender inequality in SRH has declined and even reversed over time and is substantially linked to differences in educational status. Swiss public health strategies should particularly target the younger adults with only primary school education of both genders; for women, to combat health burdens in their early life, and men, to mitigate issues in their later life.
我们的研究旨在描述1997年至2012年居住在瑞士的25至84岁成年人自评健康状况（SRH）的时间变化，以确定健康状况下降的风险群体。
基于人群的横断面健康调查的二次分析。
数据来自1997年、2002年、2007年和2012年的横断面、基于人群的五年期瑞士健康调查。共纳入63861人的数据。采用多水平混合效应逻辑回归分析，在分层交叉分类年龄-时期-队列模型（HAPC）框架内估计健康状况非常好和良好的概率，并对教育水平、性别、婚姻状况、吸烟状况和体重指数进行调整。
受过高等教育的人比受过初等教育的人更有可能报告良好的SRH（中等教育的OR = 2.12；95%CI = 1.93 - 2.33，高等教育的OR = 3.79；95%CI = 3.39 - 4.23）。教育效应取决于出生队列和年龄：1940年出生队列以后，中等教育（8%-17%）和高等教育（10%-22%）人群报告良好SRH的比例高于初等教育人群；中等/高等教育（与初等教育相比）人群报告良好SRH的比例随年龄增长而增加（45-50岁时增加10/11% , 80-84岁时增加25/36%）。1955年（初等教育）和1960年（中等教育）出生队列实现了性别健康平等，而从1975年出生队列起，这些女性在报告良好SRH方面超过了男性。受过高等教育的年轻女性报告良好SRH的可能性明显低于男性，但在退休年龄左右实现了平等。同样，初等和中等教育人群中的性别不平等在年轻时有所减少，在55岁左右不再显著，65岁起女性超过男性。
教育水平较低的年轻出生队列在SRH方面似乎最脆弱。随着教育水平逐步提高，教育效应会累积增加。虽然女性报告的健康状况低于男性，但SRH方面的性别不平等随着时间的推移有所下降甚至逆转，并且与教育状况的差异密切相关。瑞士的公共卫生策略应特别针对仅受过小学教育的年轻成年人，对女性而言，要应对其早年的健康负担，对男性而言，要缓解其晚年的问题。
