Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia.
Oxford Maternal and Perinatal Health Institute (OMPHI), University of Oxford, Oxford, England.
Biomedica. 2020 Jun 15;40(2):296-308. doi: 10.7705/biomedica.4818.
Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals' social surroundings and environment.
To investigate individual, household, and locality factors associated with self-rated ealth in Colombian adults.
We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression.
The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables.
These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.
自评健康状况与发病率和死亡率密切相关。它主要受到个人因素的影响，但也受到个人的社会环境和环境的影响。
调查与哥伦比亚成年人自评健康相关的个体、家庭和地方因素。
我们使用来自国家数据库的数据，对 19 个城市地区和 37352 名嵌套在 15788 个家庭中的个体进行了一项基于人群的横断面多水平研究。考虑到数据的自然层次结构，通过拟合三级逻辑回归获得与个体、家庭和地方特征相关的自评健康的调整后的多水平逻辑模型估计值。
调整后的多水平逻辑模型显示，在个体水平上，自评健康状况较差的风险在老年人、社会经济地位较低的人、没有伴侣的人、没有定期进行体育锻炼的人以及患有多种疾病的人当中较高。在家庭层面，自评健康状况较差与社会经济地位较低的家庭、靠近噪音源和工厂的家庭以及位于污染和不安全地区的家庭有关。在地方层面，只有在调整了个体和家庭变量后，贫困才与自评健康状况较差相关。
这些结果突出表明，在设计和实施旨在改善拉丁美洲城市人口健康状况的战略和方案时，需要采用更综合的框架。
