CISA - Centro de Investigação em Saúde de Angola (Health Research Centre of Angola), Hospital Geral do Caxito, Rua Direita, Caxito, Angola.
Instituto de Saúde Pública da Universidade do Porto (ISPUP), Oporto, Portugal.
BMC Public Health. 2021 May 25;21(1):979. doi: 10.1186/s12889-021-11003-4.
Assessing subjective social status (SSS) may be easily accommodated in the context of a Health and Demographic Surveillance System (HDSS). To our knowledge, no prior studies have examined the association of SSS and health in Angola. Subjective socioeconomic measures may provide a rapid assessment of a relevant social status construct, important for studying health inequalities. In this study, we addressed social determinants of health by examining the relationship between the subjective and objective social status, reported health and healthcare-seeking behaviour.
This research results from a cross-sectional study performed during 2015 in the Dande HDSS, in Angola. We tested the application of the MacArthur scale as a measure of SSS in a developing setting, in a sample of 12,246 households. First, we investigated its relation to objective socioeconomic indicators, and then we explored how subjective and objective social status associate with health reported needs and health-seeking behaviour of the surveyed population. Chi-square, ANOVA tests, and Receiver Operating Characteristics (ROC) Curves analysis were computed for testing relationships between subjective status ladder quartiles, sociodemographic and household characteristics. Logistic regression was used to examine the influence of subjective perception of status in self-reported health and health-seeking behaviour.
Our findings suggest that the SSS follows a gradient distribution obtained with more objective socioeconomic indicators. Additionally, we found that subjective perception of status influence health needs reporting and health-seeking behaviour and its significant effect remained after controlling for the objective socioeconomic markers. Individuals standing in the second quartile of the social ladder have more odds of reporting illness and those in the highest quartiles of the ladder were twice more likely (OR = 2.23, 95% CI = 1.52-3.26) to seek help from formal health services than those at the bottom of the ladder.
The MacArthur Scale is a valuable tool to measure SSS in the Dande HDSS, relevant for studying socioeconomic disparities and health inequalities. It is also an easier alternative to traditional measures such as income, usually difficult to measure in developing settings. The social perception of status should be considered as a complement with objective indicators when exploring social determinants of health.
在健康和人口监测系统（HDSS）的背景下，评估主观社会地位（SSS）可能很容易实现。据我们所知，以前没有研究探讨过安哥拉 SSS 与健康之间的关系。主观社会经济措施可能为研究健康不平等问题提供对相关社会地位结构的快速评估。在这项研究中，我们通过考察主观和客观社会地位、报告的健康状况和寻求医疗保健行为之间的关系，研究了健康的社会决定因素。
本研究是 2015 年在安哥拉的丹德 HDSS 进行的一项横断面研究的结果。我们测试了麦克阿瑟量表作为一种衡量发展中环境下 SSS 的方法，在 12246 户家庭的样本中进行了测试。首先，我们研究了它与客观社会经济指标的关系，然后探索了主观和客观社会地位如何与调查人群的报告健康需求和寻求医疗保健行为相关联。卡方检验、方差分析和接收器操作特性（ROC）曲线分析用于测试主观地位阶梯四分位数、社会人口学和家庭特征之间的关系。逻辑回归用于检验主观地位感知对自我报告健康和寻求医疗保健行为的影响。
我们的研究结果表明，SSS 呈现出与更多客观社会经济指标相关的梯度分布。此外，我们发现主观地位感知会影响健康需求的报告和寻求医疗保健行为，并且在控制了客观社会经济指标后，其显著影响仍然存在。处于社会阶梯第二四分位的个体更有可能报告患病，而处于阶梯最高四分位的个体寻求正规医疗服务的可能性是处于阶梯底部的个体的两倍（OR=2.23，95%CI=1.52-3.26）。
麦克阿瑟量表是在丹德 HDSS 中衡量 SSS 的一种有价值的工具，可用于研究社会经济差异和健康不平等。它也是传统收入等措施的一种更简单的替代方法，因为在发展中国家，收入通常难以衡量。在探索健康的社会决定因素时，应将社会地位的主观感知视为对客观指标的补充。
