Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway.
Centre for Health Economics, Monash University, Melbourne, VIC, Australia.
Front Public Health. 2023 Aug 22;11:1190087. doi: 10.3389/fpubh.2023.1190087. eCollection 2023.
Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway.
Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 ( = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up.
Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity.
Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.
使用相同个体随年龄增长的数据来监测多种健康行为中的教育不平等现象很少见。本研究旨在研究挪威北部生活的中年成年人中，与健康行为相关的多个变量（吸烟、身体活动、饮酒量和体重指数）以及整体健康生活方式的相对教育不平等程度的变化。
从 2008 年年龄在 32-87 岁的成年人中抽取第六和第七波特罗姆瑟研究的数据（=8906），这些数据在 2016 年进行了重复测量。使用逻辑回归评估与健康行为相关的变量中的相对教育不平等。在基线和随访时，对总样本以及男性和女性分别进行了分析。
在基线和随访时，男性和女性的所有与健康行为相关的变量中都存在教育不平等现象。较高的教育程度与更健康的类别相关（非每日吸烟、身体活动、正常体重指数和健康的生活方式），但也与高饮酒量相关。在调查期间，每日吸烟和身体活动减少，而高饮酒量、体重指数超出正常范围以及同时遵守多项健康建议的比例增加。在所有与健康行为相关的变量中，基线测量的相对教育不平等程度在随访时都有所增加。与男性相比，女性的差异更大，除了身体活动。
在挪威等福利制度完善且全面的国家，与最高教育水平和较低教育水平之间的健康行为相对差异仍然持续且不断增加。解决这些不平等问题对于减轻慢性病负担和健康方面的教育差距至关重要。
