Wang Z C, Guo Y
Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 30;53(2):314-319. doi: 10.19723/j.issn.1671-167X.2021.02.014.
To examine whether community socioeconomic status is associated with self-rated health independent of individual socioeconomic status for urban and rural residents, and to provide policy implications for improving the health status of the socioeconomically underdeveloped communities in China.
Based on the baseline data of China Family Panel Studies (CFPS) in 2010, principal component analysis was used to construct community socioeconomic index (SEI) based on average years of schooling, average income and average wealth at the community level. Community SEI was defined as the standardized first principal component score. In combination with the adult data from CFPS 2012 follow-up data, the multilevel Logistic regression model was used to analyze whether the community socioeconomic status had an independent contextual effect on the self-rated health of urban residents and rural residents after controlling individual-level socioeconomic status.
In the final analysis, 31 321 adult residents in 577 communities were included, of whom 8 423 were urban residents and 22 898 were rural residents. Community SEI ranged from -2.41 to 3.16, with a mean of 0 and a stan-dard deviation of 1. As the community SEI increased, the incidence of deprivations in different dimensions decreased, indicating the community socioeconomic status increased. The multilevel Logistic model controlling for both individual sociodemographic factors and community socioeconomic status showed that as the community SEI increased, the probability of poor self-rated health decreased, which indicated community SEI had a contextual effect on poor self-rated health. The contextual effect of community SEI on poor self-rated health was statistically significant for the rural residents (=0.84, 95%: 0.76-0.94) but not statistically significant for the urban adults (=0.94, 95%: 0.83-1.06).
After controlling for individual socioeconomic status, community socioeconomic status was associa-ted with poor self-rated health for rural residents independent of individual socioeconomic status. Therefore, in order to improve the health status of the rural population, it needs not only individual-based health interventions, but also community-based health interventions.
探讨城乡居民社区社会经济地位与自评健康之间的关联（独立于个体社会经济地位），并为改善中国社会经济欠发达社区的健康状况提供政策建议。
基于2010年中国家庭追踪调查（CFPS）的基线数据，采用主成分分析法，根据社区层面的平均受教育年限、平均收入和平均财富构建社区社会经济指数（SEI）。社区SEI被定义为标准化的第一主成分得分。结合CFPS 2012随访数据中的成人数据，使用多层次Logistic回归模型分析在控制个体层面社会经济地位后，社区社会经济地位是否对城镇居民和农村居民的自评健康有独立的背景效应。
最终分析纳入了577个社区的31321名成年居民，其中城镇居民8423名，农村居民22898名。社区SEI范围为-2.41至3.16，均值为0，标准差为1。随着社区SEI的增加，不同维度的匮乏发生率降低，表明社区社会经济地位提高。控制个体社会人口学因素和社区社会经济地位的多层次Logistic模型显示，随着社区SEI的增加，自评健康状况差的概率降低，这表明社区SEI对自评健康状况差有背景效应。社区SEI对农村居民自评健康状况差的背景效应具有统计学意义（=0.84，95%：0.76 - 0.94），但对城镇成年人不具有统计学意义（=0.94，95%：0.83 - 1.06）。
在控制个体社会经济地位后，农村居民的社区社会经济地位与自评健康状况差相关，独立于个体社会经济地位。因此，为了改善农村人口的健康状况，不仅需要基于个体的健康干预，还需要基于社区的健康干预。
