社会经济地位与健康状况和生存的不平等：罗马的一项队列研究。
Socioeconomic inequalities in health status and survival: a cohort study in Rome.
机构信息
Department of Epidemiology - Regional Health Service, ASL Roma 1, Rome, Italy
Department of Statistical Science, University of Rome La Sapienza, Rome, Italy.
出版信息
BMJ Open. 2022 Aug 19;12(8):e055503. doi: 10.1136/bmjopen-2021-055503.
OBJECTIVES
To analyse the association between individual and contextual socioeconomic position (SEP) with health status and to investigate the role of SEP and baseline health status on survival.
DESIGN
Cross-sectional and cohort study.
SETTING
Rome, Italy.
PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES: We selected the 25-99 year-olds included in the Rome 2011 census cohort. As a measure of health status on the census reference date (09 October 2011), we used the presence of chronic or rare conditions from the Disease-Related Co-payment Exemption Registry, a database implemented to provide free care to people with chronic or rare diseases. We used logistic regression to analyse the association between both individual (educational attainment) and contextual SEP (neighbourhood real estate price quintiles) with baseline health status. We analysed the role of SEP and the presence of chronic or rare conditions on 5-year survival (until 31 December 2016) using accelerated failure time models with Weibull distribution, reporting time ratios (TRs; 95% CI).
RESULTS
In middle-aged, subjects with low SEP (either individual or contextual) had a prevalence of chronic conditions comparable with the prevalence in high SEP individuals 10 years older. Adjusted logistic models confirmed the direct association between SEP and baseline health status in both women and men. The lowest educated were up to 67% more likely to have a chronic condition than the highest educated, while the difference was up to 86% for lowest versus highest contextual SEP. Low SEP and the presence of chronic conditions were associated with shorter survival times in both sexes, lowest versus highest educated TR was TR=0.79 for women (95% CI: 0.77 to 0.81) and TR=0.71 for men (95% CI: 0.70 to 0.73). The contextual SEP shrunk survival times by about 10%.
CONCLUSION
Inequalities were present in both baseline health and survival. The association between SEP and survival was independent of baseline health status.
目的
分析个体和背景社会经济地位（SEP）与健康状况的关系，并探讨 SEP 和基线健康状况对生存的影响。
设计
横断面和队列研究。
地点
意大利罗马。
参与者、主要和次要结局：我们选择了 2011 年罗马人口普查队列中 25-99 岁的人。作为普查参考日期（2011 年 10 月 9 日）健康状况的衡量标准，我们使用了疾病相关共付额豁免登记处的慢性或罕见疾病的存在情况，该数据库的建立是为了向患有慢性或罕见疾病的人提供免费护理。我们使用逻辑回归分析个体（教育程度）和背景 SEP（邻里房地产价格五分位数）与基线健康状况之间的关系。我们使用加速失效时间模型（Weibull 分布）和时间比（TR；95%CI）分析 SEP 和慢性或罕见疾病的存在对 5 年生存（截至 2016 年 12 月 31 日）的影响。
结果
在中年人群中，社会经济地位较低（个体或背景）的人群的慢性疾病患病率与高社会经济地位人群中 10 岁以上人群的患病率相当。调整后的逻辑模型在女性和男性中均证实了 SEP 与基线健康状况之间的直接关系。受教育程度最低的人患慢性疾病的可能性比受教育程度最高的人高 67%，而受教育程度最低的人与受教育程度最高的人之间的差异高达 86%。在两性中，低社会经济地位和慢性疾病的存在与较短的生存时间相关，受教育程度最低与最高的 TR 分别为女性 TR=0.79（95%CI：0.77 至 0.81）和男性 TR=0.71（95%CI：0.70 至 0.73）。背景 SEP 缩短了约 10%的生存时间。
结论
在基线健康和生存方面都存在不平等现象。SE 与生存之间的关系独立于基线健康状况。
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