Department of Sociology, University of British Columbia, Vancouver, BC, Canada.
Scand J Public Health. 2021 Dec;49(8):857-864. doi: 10.1177/1403494820917534. Epub 2020 May 13.
The study aim was to investigate whether household income mediates the association between education and health in a nationally representative sample of Canadian adults. The data came from the Longitudinal and International Study of Adults linked to income data from the Canada Revenue Agency. Odds ratios and predicted probabilities from binary logistic regression models were used to describe associations between education and (a) self-rated health, (b) longstanding illness or health problem, (c) emotional, psychological or mental health problem and (d) symptoms of psychological distress. The Karlson-Holm-Breen decomposition method was used to investigate the potentially mediating role of household income in these associations. The analyses were conducted separately for women and men. Education was significantly associated with all four health indicators for both women and men. Of the four health indicators, education was most strongly associated with self-rated health for both women and men. Education was more strongly associated with self-rated health and the presence of an emotional, psychological or mental health problem for women than for men. Curiously, men with a postgraduate degree were significantly more likely than men with a bachelor degree to report symptoms of psychological distress. Only modest proportions of the associations between education and health could be attributed to differences in household income. Education and household income manifested independent associations with all four health indicators among women and with three of four health indicators among men. Education and household income are joint independent predictors of health in Canada. Accordingly, both should be included in research on socioeconomic health inequalities in this context.
本研究旨在调查在加拿大成年人的全国代表性样本中，家庭收入是否在教育与健康之间起中介作用。数据来自与加拿大税务局收入数据相链接的成人纵向和国际研究。使用二项逻辑回归模型的比值比和预测概率来描述教育与（a）自我评估健康、（b）长期疾病或健康问题、（c）情绪、心理或心理健康问题以及（d）心理困扰症状之间的关联。使用 Karlson-Holm-Breen 分解方法来调查家庭收入在这些关联中潜在的中介作用。对女性和男性分别进行了分析。教育与女性和男性的所有四个健康指标均显著相关。在这四个健康指标中，教育与自我评估健康的相关性最强。教育与女性的自我评估健康和情绪、心理或心理健康问题的存在比男性更为密切相关。奇怪的是，拥有研究生学历的男性比拥有学士学位的男性更有可能报告出现心理困扰的症状。教育与健康之间的关联只能归因于家庭收入差异的一小部分。教育和家庭收入与女性的所有四个健康指标以及男性的三个健康指标都有独立的关联。在加拿大，教育和家庭收入是健康的共同独立预测因素。因此，在这种情况下，在研究社会经济健康不平等问题时，都应该将两者包括在内。
