Department of Physics, Polytechnic University of Catalonia, Barcelona, Spain.
Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
Int J Equity Health. 2020 Jun 5;19(1):85. doi: 10.1186/s12939-020-01202-7.
Inequalities in health across social class, gender and regional context in Spain are well-known; however, there is a lack of research examining how these dimensions of inequality interact. This study explores self-rated health (SRH) inequalities across intersectional positions of gender, social class and region, and the contribution of material and psychosocial factors to these inequalities.
Participants were drawn from the cross-sectional 2015 National Living Conditions Survey of Spanish residents aged 19-88 years (N = 27,215; 77% response rate). Eight intersectional positions were formed by combining dichotomous variables of gender, social class and regional development. Poisson regression was used to estimate intersectional inequalities in SRH as prevalence ratios, and the contributions of material and psychosocial factors.
Results showed both cumulative and heterogeneous inequalities within and across intersectional positions. Inequalities in the intersection of social class and regional development were best explained by the joint contributions of material and psychosocial factors, while gender inequalities within non-manual social class were better explained by material factors alone.
The results illustrate the complexity of interacting inequalities in health and their underpinnings in Spain. Local and national policies taking this complexity into account are needed to broadly improve equity in health in Spain.
西班牙的社会阶层、性别和地区背景下的健康不平等是众所周知的；然而，对于这些不平等维度如何相互作用的研究还很缺乏。本研究探讨了性别、社会阶层和地区的交叉位置上的自评健康（SRH）不平等，以及物质和心理社会因素对这些不平等的贡献。
参与者来自西班牙 19-88 岁居民的 2015 年全国生活条件横断面调查（N=27215；77%的回复率）。通过结合性别、社会阶层和区域发展的二分变量，形成了八个交叉位置。使用泊松回归估计 SRH 的交叉不平等作为患病率比，并评估物质和心理社会因素的贡献。
结果显示，在交叉位置内和跨交叉位置都存在累积和异质的不平等。社会阶层和区域发展的交叉不平等主要由物质和心理社会因素的共同贡献来解释，而非体力劳动社会阶层内的性别不平等则主要由物质因素来解释。
结果说明了健康相互作用的不平等的复杂性及其在西班牙的基础。需要考虑到这种复杂性的地方和国家政策，以广泛改善西班牙的健康公平。
