Department of Family Medicine, Queen's University, Kingston, ON, Canada.
Department of Public Health Sciences, Queen's University, Centre for Studies in Primary Care, 220 Bagot St, Kingston, ON, K7L 5E9, Canada.
BMC Geriatr. 2021 Aug 28;21(1):473. doi: 10.1186/s12877-021-02412-6.
Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations.
We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models.
After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed.
Sex and social factors affected older adults' perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.
自评健康 (SRH) 是衡量老年人整体健康状况的一种广泛验证的方法。我们的目的是了解哪些因素塑造了个体对健康的认知，特别是这些认知是否因性别和社会地位而异。
我们使用了来自加拿大老龄化纵向研究 (CLSA) 的社区居住的 45 至 85 岁成年人的数据。SRH 通过标准的单一问题进行衡量。多泊松回归确定了与 SRH 相关的个体、行为和社会因素。使用多层模型量化了性别、教育、财富和城乡地位之间的交叉点以及个体和联合聚类效应对 SRH 的影响。
在调整了相关混杂因素后，女性报告 SRH 不佳的可能性降低了 43%。最强的聚类效应是财富分组（21%）。当按性别或教育将财富聚类细分时，对 SRH 的总体影响降低到 15%。SRH 的最大变化（13.6%）发生在性别、财富和城乡地位的交叉点。相比之下，性别和社会因素之间的相互作用并不显著，这表明只有当采用交叉方法时，性别和社会地位的复杂相互作用才会显现出来。
性别和社会因素以复杂的方式影响老年人对健康的认知，只有通过多层次分析才能显现出来。利用交叉性分析是一种新颖而微妙的方法，可以理清主观健康结果的解释。
