Medical Sociology, Hannover Medical School, Hannover, Germany
Medical Sociology, Hannover Medical School, Hannover, Germany.
BMJ Open. 2021 Mar 4;11(3):e042017. doi: 10.1136/bmjopen-2020-042017.
While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years).
We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time.
With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCS=2.76, 95% CI 0.41 to 5.11; MCS=1.05, 95% CI 1.01 to 1.10; PCS=2.12, 95% CI -0.27to 4.51; PCS=1.05, 95% CI 1.00 to 1.11; poor SRH=-0.10, 95% CI -0.19 to 0.01; poor SRH=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCS=2.82, 95% CI 0.16 to 5.50; MCS=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCS=-2.98, 95% CI -4.86 to -1.11; PCS=0.94, 95% CI 0.90 to 0.98; poor SRH=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders.
We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants.
尽管有证据表明健康不平等现象持续存在，但很少有研究探讨这些趋势是否会因生命的不同阶段而有所不同。在此背景下，我们分析了“后工作阶段”（50-64 岁）、“年轻老年人”（65-79 岁）和“老年人”（80 岁以上）中与健康相关的生活质量（HRQOL）和自评健康不良（SRH）方面的教育不平等现象在不同生命阶段的变化趋势。
我们使用了德国社会经济面板研究的数据，该研究涵盖了 2002 年至 2016 年的时间段。样本由 26074 名年龄在 50 岁及以上的受访者（160888 人年）组成。健康状况通过 HRQOL 问卷（12 项简短健康调查 V.2）的心理和生理成分综合量表（MCS/PCS）和单一的 SRH 进行评估。为了估计教育健康不平等，我们计算了基于回归的不平等斜率指数（SII）和相对不平等指数（RII）。通过在学校教育和时间之间加入双向交互项来评估不平等的时间趋势。
随着年龄的增长，PCS 和自评健康不良的教育不平等程度降低，而 MCS 的教育不平等程度则上升。随着时间的推移，65-79 岁男性的健康不平等程度有所下降（MCS=2.76，95%CI 0.41 至 5.11；MCS=1.05，95%CI 1.01 至 1.10；PCS=2.12，95%CI-0.27 至 4.51；PCS=1.05，95%CI 1.00 至 1.11；自评健康不良=-0.10，95%CI-0.19 至 0.01；自评健康不良=0.73，95%CI 0.48 至 1.13），该年龄组女性的 MCS 也出现了类似的情况（MCS=2.82，95%CI 0.16 至 5.50；MCS=1.06，95%CI 1.01 至 1.12）。相比之下，女性的“后工作阶段”健康不平等程度扩大（PCS=-2.98，95%CI-4.86 至-1.11；PCS=0.94，95%CI 0.90 至 0.98；自评健康不良=0.07，95%CI 0.00 至 0.14），而在两性的老年阶段，健康不平等程度基本保持稳定。
我们发现，健康不平等趋势的模式因性别和生命阶段而异。我们的研究结果表明，需要对健康不平等趋势采取差异化的观点，并进行研究以探索其潜在的决定因素。
