Nanjing Gulou District Center for Disease Control and Prevention, Nanjing, China.
Department of Epidemiology, School of Public Health, Nanjing Medical University, 101 Longmian Ave., Nanjing, 211166, People's Republic of China.
BMC Public Health. 2021 Mar 17;21(1):527. doi: 10.1186/s12889-021-10600-7.
To examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China.
A cross-sectional survey was conducted among urban and rural adults (aged 25-69 years) who were randomly selected, using the probability proportionate to size sampling approach, from Nanjing municipality of China during October and December of 2016. HL, the outcome variable, was assessed using the Chinese Resident Health Literacy Scale. SEP, our independent variable, was separately measured with educational attainment, monthly family average income and occupation. Logistic regression models were introduced to examine SEP-HL association with odds ratio (OR) and 95% confidence interval (CI).
Totally, 8698 participants completed the survey. The proportion of participants with unweighted and weighted adequate HL was 18.0% (95%CI = 17.2, 18.8%) and 19.9% (95%CI = 16.6, 23.6%), respectively, in this study. After adjustment for possible confounding factors, each SEP indicator was in significantly positive relation to both unweighted and weight HL level. Participants who obtained 13+ and 10-12 years educational attainment, respectively, had 2.41 (95%CI = 1.60, 3.64) and 1.68 (95%CI = 1.23, 2.29) times odds to record weighted adequate HL compared to their counterparts who were with 0-9 years education. Subjects within upper (OR = 1.92, 95%CI = 1.24, 2.98) and middle FAI tertile (OR = 1.59, 95%CI = 1.19, 2.13), respectively, were more likely to report weighted adequate HL relative to those who were within lower FAI tertile. White collars were more likely to have weighted adequate HL (OR = 1.33, 95%CI = 1.09, 1.61) than blue collars.
Each of education, FAI and occupation was positively associated with health literacy among urban and rural adults in China. The findings have important implications that different SEP indicators can be used to identify vulnerable residents in population-based health literacy promotion campaigns.
本研究旨在探讨社会经济地位（SEP），分别由教育、家庭月平均收入（FAI）和职业来表示，与中国某一地区成年人健康素养（HL）之间的关系。
2016 年 10 月至 12 月期间，采用按比例概率抽样法，从中国南京市的城乡成年人（25-69 岁）中随机抽取参与者进行横断面调查。HL 是本研究的因变量，采用中国居民健康素养量表进行评估。SEP 是本研究的自变量，分别用受教育程度、家庭月平均收入和职业来衡量。采用逻辑回归模型，以比值比（OR）和 95%置信区间（CI）来检验 SEP-HL 之间的关联。
共有 8698 名参与者完成了调查。在未加权和加权的情况下，分别有 18.0%（95%CI=17.2,18.8%）和 19.9%（95%CI=16.6,23.6%）的参与者具有足够的 HL。在调整了可能的混杂因素后，每个 SEP 指标与未加权和加权 HL 水平均呈显著正相关。与受教育年限为 0-9 年的参与者相比，受教育年限为 13 年及以上和 10-12 年的参与者分别有 2.41（95%CI=1.60,3.64）和 1.68（95%CI=1.23,2.29）倍的几率记录加权足够的 HL。处于较高（OR=1.92，95%CI=1.24,2.98）和中等 FAI 三分位（OR=1.59，95%CI=1.19,2.13）的参与者分别比处于较低 FAI 三分位的参与者更有可能报告加权足够的 HL。白领比蓝领更有可能有加权足够的 HL（OR=1.33，95%CI=1.09,1.61）。
在中国城乡成年人中，教育、FAI 和职业均与 HL 呈正相关。这些发现具有重要意义，即不同的 SEP 指标可用于识别基于人群的健康素养促进活动中的弱势居民。
