Department of Biostatistics, Miller Scientific, Johnson City, TN.
University of California Los Angeles, Los Angeles, CA.
Medicine (Baltimore). 2023 Aug 11;102(32):e34488. doi: 10.1097/MD.0000000000034488.
The number of Americans who report dissatisfaction with their quality of life has increased over the past several decades. This study investigated social- and health-related determinants of life dissatisfaction among adults in the United States (US). We conducted a cross-sectional observational study using data from the 2021 National Health Interview Survey, a nationally representative sample of adults in the US. We analyzed the association between self-reported life dissatisfaction and independent variables including demographics, family-level information, health status and conditions, functioning and disability, health insurance coverage, chronic pain, occupational variables, socioeconomic indicators, health-related behaviors, and psychological distress indicators. Survey multivariable logistic regression was used to determine the association among social- and health-related determinants and life dissatisfaction. The relative importance of each variable in the final model was determined using Shapley Additive Explanations values (0-100% scale). Among the 253.2 million civilian noninstitutionalized adults, 12.2 million (4.8%) reported life dissatisfaction. Recent psychological distress, unmarried status, poor general health, lack of social/emotional support, and lower food security were independently associated with life dissatisfaction (all P < .001). The relative importance of these variables in predicting life dissatisfaction was 39.3% for recent psychological distress, 22.2% for unmarried status, 18.3% for poor general health, 13.4% for lack of social/emotional support, and 6.9% for lower food security. Additionally, racial inequities were identified in the prevalence of these factors. Life dissatisfaction among adults in the US is associated with social- and health-related factors that are more prevalent in racial minority groups. The study findings suggest that resource prioritization should be targeted towards individuals with these factors, with particular emphasis on racial minority groups. This study aligns with US health policy initiatives and the results may help policymakers address the underlying factors contributing to life dissatisfaction among the US population.
在过去的几十年里，报告对生活质量不满的美国人数量有所增加。本研究调查了美国成年人生活不满的社会和健康相关决定因素。我们使用来自美国全国健康访谈调查的 2021 年数据进行了一项横断面观察性研究，这是美国成年人的全国代表性样本。我们分析了报告的生活不满与独立变量之间的关联，这些变量包括人口统计学、家庭水平信息、健康状况和疾病、功能和残疾、医疗保险覆盖范围、慢性疼痛、职业变量、社会经济指标、与健康相关的行为和心理困扰指标。调查多变量逻辑回归用于确定社会和健康相关决定因素与生活不满之间的关联。使用 Shapley 加法解释值（0-100% 刻度）确定最终模型中每个变量的相对重要性。在 25320 万非机构化的平民成年人中，有 1220 万人（4.8%）报告生活不满。最近的心理困扰、未婚状态、一般健康状况差、缺乏社会/情感支持以及较低的粮食安全与生活不满独立相关（均 P<0.001）。这些变量预测生活不满的相对重要性分别为最近心理困扰的 39.3%、未婚状态的 22.2%、一般健康状况差的 18.3%、缺乏社会/情感支持的 13.4%和粮食安全较低的 6.9%。此外，还确定了这些因素在种族少数群体中的流行率存在不平等现象。美国成年人的生活不满与社会和健康相关因素有关，这些因素在种族少数群体中更为普遍。研究结果表明，资源应优先分配给有这些因素的个人，特别是种族少数群体。这项研究与美国卫生政策倡议一致，结果可能有助于决策者解决导致美国人口生活不满的根本因素。
