Guo Yingqi, Chan Kristy Shuk Ting, Chan Chee Hon, Chang Qingsong, Lee Ruby Sy, Yip Paul Siu Fai
Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
BMJ Open. 2021 Apr 27;11(4):e043192. doi: 10.1136/bmjopen-2020-043192.
This study examined the interaction effects of individual and neighbourhood socioeconomic status (SES) in older adults in Hong Kong, considering all-cause and cause-specific mortality from respiratory disease, cancer, cardiovascular diseases, ischaemic heart disease, stroke, nonmedical disease and suicide.
A retrospective follow-up study.
Hong Kong Special Administrative Region, a rapidly ageing society with 16.1% residents aged 65 years or older in 2020.
43 910 people aged 65 years or older were enrolled at baseline. They had participated in health check-ups during 2000-2003 in one of the Elderly Health Centres. Observation periods started on the date of the participant's first health check-up, and ended at death, or 31 December 2011, whichever occurred first.
All-cause and cause-specific mortality over the study timeframe.
Cox's proportional hazards regression models were applied to estimate the adjusted HRs of mortality, by including covariates at neighbourhood (deprivation) and individual levels (poverty, education and type of housing).
The 'double tragedy theory' (ie, lower SES persons living in lower SES neighbourhoods have worst health outcomes) was more related to cancer, while the 'psychosocial comparison theory' (ie, lower SES persons living in higher SES neighbourhoods have poorer health outcomes) was more related to cardiovascular, ischaemic heart disease, and stroke.
There were important interaction effects between neighbourhood and individual factors on mortality. Policies based on the interaction between individual and neighbourhood SES should be considered. For instance, for cancer, targeted services (ie, free consultation, relevant treatment information, health check-up, etc) could be allocated in socioeconomically deprived areas to support individuals with low SES. On the other hand, more free public services to reduce psychological stresses (ie, psychological support services, recreational services, health knowledge information, etc) could be provided for those individuals with low SES living in higher SES areas to reduce stroke, cardiovascular and ischaemic heart diseases.
本研究考察了香港老年人个体及邻里社会经济地位（SES）的交互作用，涵盖全因死亡率以及呼吸系统疾病、癌症、心血管疾病、缺血性心脏病、中风、非医学疾病和自杀等特定病因死亡率。
一项回顾性随访研究。
香港特别行政区是一个快速老龄化的社会，2020年有16.1%的居民年龄在65岁及以上。
43910名65岁及以上的人在基线时被纳入研究。他们于2000年至2003年期间在其中一家老年健康中心参加了健康检查。观察期从参与者首次健康检查之日开始，至死亡或2011年12月31日结束，以先发生者为准。
研究时间段内的全因死亡率和特定病因死亡率。
应用Cox比例风险回归模型来估计死亡率的调整后风险比，纳入邻里（贫困程度）和个体层面（贫困、教育程度和住房类型）的协变量。
“双重悲剧理论”（即生活在社会经济地位较低邻里的社会经济地位较低者健康状况最差）与癌症的关联性更强，而“社会心理比较理论”（即生活在社会经济地位较高邻里的社会经济地位较低者健康状况较差）与心血管疾病、缺血性心脏病和中风的关联性更强。
邻里因素和个体因素在死亡率方面存在重要的交互作用。应考虑基于个体与邻里社会经济地位交互作用的政策。例如，对于癌症，可在社会经济贫困地区提供针对性服务（如免费咨询、相关治疗信息、健康检查等），以支持社会经济地位较低的个体。另一方面，对于生活在社会经济地位较高地区的社会经济地位较低的个体，可提供更多免费公共服务以减轻心理压力（如心理支持服务、娱乐服务、健康知识信息等），以降低中风、心血管疾病和缺血性心脏病的发生率。
