Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
PLoS One. 2020 Sep 17;15(9):e0239031. doi: 10.1371/journal.pone.0239031. eCollection 2020.
Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature.
We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013-July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis.
Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health.
We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants' influence.
确定健康决定因素并了解其在健康生产中的作用是一个重要的研究主题。我们旨在记录文献中关于这一主题的近期多国研究现状。
我们遵循 PRISMA-ScR 指南，系统地识别、筛选和审查文献（2013 年 1 月至 2019 年 7 月）。我们搜索了旨在评估一个或多个综合水平决定因素对高收入国家一个或多个一般人群健康结果影响的跨国统计分析研究。为了评估个体（或主题相关）决定因素是如何组合在一起以及在何种程度上一起研究的，我们进行了多维缩放和聚类分析。
从最初的 3686 项中筛选出 60 项研究。预期寿命和总体死亡率是使用最广泛的人群健康指标，而决定因素来自医疗保健、文化、政治、社会经济、环境、劳动力、生育、人口统计学、生活方式和心理学领域。回归模型家族是主要的统计方法。我们多维缩放的结果表明，一个相对紧密的核心决定因素受到了广泛关注，作为主要的感兴趣的协变量或对照因素，而大多数其他决定因素的研究范围非常有限。我们认为目前关于任何给定健康决定因素重要性的研究结果尚无定论。在大量的模型规范、不同的国家样本和不同的时间段内，效应在统计学上显著和不显著之间波动，对健康有益和有害之间波动。
我们得出结论，理解人口健康潜在机制的努力还远远没有定论，目前关于这一主题的研究状况还有很多不足之处。未来的研究必须同时考虑多个因素，并利用更复杂的方法来量化健康以及分析决定因素的影响。
