Assari Shervin, Cobb Sharon, Bazargan Mohsen
Department of Family Medicine, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90095, USA.
School of Nursing, Charles R. Drew University of Medicine and Sciences, Los Angeles, CA 90095, USA.
J Health Econ Dev. 2019 Summer;1(2):9-21. Epub 2019 Sep 20.
Educational attainment and income are central to maintenance of body mass index (BMI), physical activity, and self-rated health (SRH). However, less is known about how social groups differ in the role of educational attainment and income on subsequent changes in these health outcomes. This study compared race/ethnicity by gender groups of older Americans for the effects of baseline educational attainment and income on subsequent changes in BMI, physical activity, and SRH.
The Health and Retirement Study (HRS) followed 37,495 male and female White and African American people above age 50 for 6 years from 2004 to 2010. This number included 15,581 White women, 12,495 White men, 5,580 African American women, and 3,839 African American men. Physical activity, BMI, and SRH were measured every two years. Multi-group structural equation modeling (latent growth curve modeling) was used to compare race/ethnicity by gender groups for the protective effects of educational attainment and income in 2004 on a decline in physical activity, BMI, and SRH from 2004 to 2010.
Major race/ethnicity by gender differences were observed in the effects of baseline educational attainment and income on changes in BMI, physical activity, and SRH. Educational attainment and income showed more salient roles for White men and women than African American men and women. To give some examples, baseline education (years) was associated with changes in physical activity of White women and changes in BMI of White men, while baseline income was associated with changes in SRH of White Women. We did not find evidence suggesting that baseline income fully mediates the effect of baseline educational attainment on health outcomes, as in many instances, educational attainment but not income was associated with health changes over time.
The intersection of race/ethnicity and gender alters how educational attainment and income protects against subsequent changes in physical activity, BMI, and SRH. Social groups may vary in operant mechanisms by which social determinants of health prevent health decline in the United States.
受教育程度和收入对于维持体重指数（BMI）、身体活动水平以及自评健康状况（SRH）至关重要。然而，关于不同社会群体在受教育程度和收入对这些健康结果后续变化的影响方面存在何种差异，我们所知甚少。本研究比较了美国老年人群中按性别划分的种族/族裔群体，以探讨基线受教育程度和收入对后续BMI、身体活动水平和SRH变化的影响。
健康与退休研究（HRS）在2004年至2010年期间，对37495名年龄在50岁以上的白人和非裔美国男性及女性进行了为期6年的跟踪调查。这一数字包括15581名白人女性、12495名白人男性、5580名非裔美国女性和3839名非裔美国男性。每两年测量一次身体活动水平、BMI和SRH。采用多组结构方程模型（潜在增长曲线模型），比较按性别划分的种族/族裔群体在2004年受教育程度和收入对2004年至2010年身体活动水平下降、BMI和SRH下降的保护作用。
在基线受教育程度和收入对BMI、身体活动水平和SRH变化的影响方面，观察到了按性别划分的主要种族/族裔差异。受教育程度和收入对白人男性和女性的作用比对非裔美国男性和女性更为显著。举例来说，基线教育年限（年）与白人女性身体活动水平的变化以及白人男性BMI的变化相关，而基线收入与白人女性SRH的变化相关。我们没有发现证据表明基线收入完全介导了基线受教育程度对健康结果的影响，因为在许多情况下，随着时间推移，与健康变化相关的是受教育程度而非收入。
种族/族裔与性别的交叉影响改变了受教育程度和收入对后续身体活动水平、BMI和SRH变化的保护方式。在美国，不同社会群体在健康的社会决定因素预防健康下降的作用机制方面可能存在差异。
