Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, B3H1V7, Canada.
Department of Economics, Department of Health, Aging & Society, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, L8S4M4, Canada.
Soc Sci Med. 2020 Nov;265:113382. doi: 10.1016/j.socscimed.2020.113382. Epub 2020 Sep 22.
Self-rated health is widely used in studies of the socioeconomic gradient of health in community-based populations. Its subjectivity may lead to under- or over-estimation of a true underlying socioeconomic gradient and has increased interest in searching for alternative, objective measures of health. Grip strength has emerged as one such alternative for community-based older populations, yet no study has directly assessed the relationship between these two measures and compared their associations with socioeconomic status and health behaviours. Using 26,754 participants aged 45-85 years in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort, we estimated adjusted-grip strength through indirect standardization using age, sex, height, weight, and their square terms and used ANOVA to assess the variance of adjusted-grip strength within and between each self-rated health category. We ran four separate logistic regression models, examining unhealthy tails (those reporting poor health vs. not and those at the bottom 8th percentile of adjusted-grip strength vs. above) and healthy tails (those reporting excellent health vs. not and those at the top 20th percentile of adjusted-grip strength vs. below). Stronger adjusted-grip strength correlated with better self-rated health, but only 2% of the total variance of adjusted-grip strength was explained by variance between the self-rated health categories. While self-rated health largely showed the expected socioeconomic gradients and positive relationships with health enhancing behaviours, adjusted-grip strength showed no clear, consistent associations with either socioeconomic or health behaviour variables. The results give caution about using grip strength as an objective alternative to self-rated health in studies of social inequalities in health. Empirical approaches demand careful considerations as to which dimensions of health and corresponding measures of health are most relevant to the context being studied.
自评健康被广泛应用于社区人群健康的社会经济梯度研究中。其主观性可能导致对真实潜在社会经济梯度的低估或高估，这增加了寻找替代的、客观的健康衡量标准的兴趣。握力作为一种针对社区老年人的替代方法已经出现，但尚无研究直接评估这两种方法之间的关系，并比较它们与社会经济地位和健康行为的关联。我们使用加拿大老龄化纵向研究综合队列的基线数据中 26754 名 45-85 岁的参与者，通过间接标准化估计调整后的握力，使用年龄、性别、身高、体重及其平方项，并使用方差分析评估每个自评健康类别内和之间调整后的握力的方差。我们运行了四个独立的逻辑回归模型，检查不健康的尾巴（那些报告健康状况不佳的人与那些报告健康状况良好的人相比，以及那些调整后的握力处于第 8 百分位以下的人与那些处于第 8 百分位以上的人相比）和健康的尾巴（那些报告健康状况极佳的人与那些报告健康状况不佳的人相比，以及那些调整后的握力处于第 20 百分位以上的人与那些处于第 20 百分位以下的人相比）。较强的调整后的握力与较好的自评健康相关，但只有 2%的调整后的握力总方差可以通过自评健康类别之间的方差来解释。虽然自评健康在很大程度上显示了预期的社会经济梯度和与促进健康行为的正相关关系，但调整后的握力与社会经济或健康行为变量之间没有明确、一致的关联。这些结果表明，在研究健康方面的社会不平等时，使用握力作为自评健康的客观替代方法需要谨慎。实证方法需要仔细考虑与正在研究的背景最相关的健康维度和相应的健康衡量标准。
