Lai Eric T C, Ho Hung Chak, Ho Suzanne C, Woo Jean
Jockey Club Institute of Ageing, Chinese University of Hong Kong, New Territories, Hong Kong; Institute of Health Equity, Chinese University of Hong Kong, New Territories, Hong Kong.
Department of Urban Planning and Design, The University of Hong Kong, Pokfulam, Hong Kong.
J Am Med Dir Assoc. 2022 May;23(5):858-864.e5. doi: 10.1016/j.jamda.2021.08.034. Epub 2021 Sep 20.
It is inconsistent in the literature on whether inequalities of health in older age widen or narrow over time. We assessed the associations of socioeconomic status (SES), physical functioning, and mortality in an older age cohort in Hong Kong.
Longitudinal cohort study.
We recruited 2032 older adults aged 70+ in 1991 to 1992 and followed them for 10 years.
SES was operationalized as education, baseline individual income, and longest-held occupation in lifetime. Physical functioning was measured by Barthel's Index for activities of daily living (ADL), from which disability was defined as ADL score <20. Mortality data were obtained from the Death Registry. Bayesian joint modeling with 2 sub-models, mixed-effect, and Cox proportional hazard model, were used to respectively model the associations of SES and disability, and SES and mortality, accounting for selection by mortality.
Education and income at baseline were not clearly related to disability, but those with lower education level and income at baseline tended to have their risks increased with time. Older adults who had been mostly economically inactive or unemployed in their lifetime had higher risk of disability [odds ratio 3.24; 95% credible interval (95%CrI) 1.29 to 7.97], and such risk increased over time. For mortality, older adults with no schooling were at higher risk compared with those with secondary education or above (hazard ratio 1.25; 95%CrI 1.00 to 1.57). Income at baseline and longest-held occupation in lifetime were not clearly related to mortality.
We observed inequalities of health of older adults in Hong Kong that widened as they age. Community and medical interventions targeting the older adults with the lowest SES would be important to prevent their more rapid decline in physical functioning.
关于老年人群健康不平等现象随时间推移是扩大还是缩小，文献中的观点并不一致。我们评估了香港一个老年队列中社会经济地位（SES）、身体功能和死亡率之间的关联。
纵向队列研究。
我们在1991年至1992年招募了2032名70岁及以上的老年人，并对他们进行了10年的随访。
SES通过教育程度、基线个人收入和一生中从事时间最长的职业来衡量。身体功能通过巴氏日常生活活动指数（ADL）进行测量，其中残疾定义为ADL得分<20。死亡率数据来自死亡登记处。使用具有2个子模型的贝叶斯联合建模、混合效应模型和Cox比例风险模型，分别对SES与残疾、SES与死亡率之间的关联进行建模，同时考虑死亡率导致的选择偏倚。
基线时的教育程度和收入与残疾没有明显关联，但基线时教育水平和收入较低的人，其风险往往会随时间增加。一生中大部分时间经济不活跃或失业的老年人残疾风险更高[比值比3.24；95%可信区间（95%CrI）1.29至7.97]，且这种风险随时间增加。对于死亡率，未受过教育的老年人比受过中等教育或以上的老年人风险更高（风险比1.25；95%CrI 1.00至1.57）。基线收入和一生中从事时间最长的职业与死亡率没有明显关联。
我们观察到香港老年人的健康不平等现象随着年龄增长而扩大。针对社会经济地位最低的老年人的社区和医疗干预措施对于防止他们身体功能更快衰退至关重要。
