Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.
J Am Med Dir Assoc. 2023 Jun;24(6):811-815. doi: 10.1016/j.jamda.2023.01.009. Epub 2023 Feb 20.
To assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans.
Health and Retirement Study, a longitudinal survey of older American adults.
Data pooled from 2006 to 2018 (waves 8-14), which include 38,061 participants.
We used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education.
African American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18-1.23 and 1.11; 95% CI 1.17-1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44-1.51) and 1.31 (95% CI 1.26-1.36) after accounting for behaviors.
Ethnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.
评估美国老年人中多种疾病进展的社会经济和种族不平等现象，以及行为因素是否可以解释这些不平等现象。
健康与退休研究（Health and Retirement Study），一项针对美国老年人的纵向调查。
纳入了 2006 年至 2018 年（第 8-14 波）的数据，共有 38061 名参与者。
我们使用了 2006 年至 2018 年的 7 波调查数据。社会经济因素由教育程度、总财富、贫困收入比（收入）和种族/民族表示。多种疾病由 5 种慢性疾病的自我报告诊断表示：糖尿病、心脏疾病、肺部疾病、癌症和中风。行为因素由吸烟、过度饮酒、身体活动和体重指数（BMI）表示。构建了多水平混合效应广义线性模型，以评估多种疾病进展中的社会经济和种族不平等现象，以及行为的作用。除了性别、种族/民族和教育程度外，所有纳入分析的变量均为时变变量。
非裔美国人的多种疾病发病率高于白人；然而，在调整收入和教育程度后，这种关联发生了逆转。多种疾病的进展存在明显的收入、财富和教育梯度。在调整行为因素后，这种关系减弱了。在未调整和调整行为因素的模型中，教育程度最低组的参与者的多种疾病发病率分别降低了 9%（调整后发病率比[RR]为 1.21；95%置信区间[CI]为 1.18-1.23 和 1.11；95%CI 为 1.17-1.14）。同样，在考虑行为因素的情况下，财富最低四分位数的参与者的多种疾病 RR 从 1.47（95%CI 为 1.44-1.51）和 1.31（95%CI 为 1.26-1.36）降低。
多种疾病进展中的种族不平等现象可以用财富、收入和教育程度来解释。行为因素部分减轻了多种疾病的社会经济不平等现象。这些发现有助于确定应纳入旨在解决多种疾病不平等问题的健康促进计划中的行为因素。
