HEC Montréal, 3000 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 2A7, Canada.
ESG-UQAM, 315, Sainte-Catherine Street East, Montreal, QC, H2X 3X2, Canada; CIRANO, 130 Sherbrooke Street West #1400, Montreal, QC, H3A 2M8, Canada.
Health Policy. 2020 Mar;124(3):326-335. doi: 10.1016/j.healthpol.2019.12.015. Epub 2020 Jan 17.
Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.
受教育程度不同导致的健康不平等现象在时间上和国家间都是长期存在的。然而，它们的程度、演变和主要驱动因素在不同司法管辖区并不一定一致。我们考察了美国、加拿大、法国、荷兰、西班牙和意大利的老年人群体中健康状况恶化与教育程度之间的关系，包括 2004 年至 2010 年间这一关系的时间变化。我们使用纵向调查数据，首先评估了健康恶化（表现为健康状况不佳、日常生活活动困难和慢性病）的发生率随教育程度的变化情况。我们发现，不同国家之间在健康恶化的发生率以及健康恶化与教育程度之间的梯度方面存在系统性差异。然后，我们考察了潜在的混杂因素（包括人口特征、收入、医疗保健利用和健康行为）如何随时间影响各国的健康恶化与教育程度之间的关系。我们的研究结果表明，虽然调整混杂因素通常会降低健康恶化与教育程度之间的梯度，但这些变量的影响在不同国家之间存在一定差异。我们的研究结果表明，影响健康恶化与教育程度之间关系的决定因素以及可能的政策手段可能因国家和医疗体系的不同而有所不同。
