Abdalla Salma M, Assefa Ethan, Rosenberg Samuel B, Hernandez Mark, Koya Shaffi Fazaludeen, Galea Sandro
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Commun Med (Lond). 2024 Jun 6;4(1):107. doi: 10.1038/s43856-024-00493-z.
A clear understanding of public perceptions of the social determinants of health remains lacking. This paper aimed to describe the relationship between income and urbanicity levels and public views of the determinants of health in eight middle-and high-income countries that varied across multiple characteristics.
We conducted a cross-sectional online survey in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States. Respondents were asked to select what they considered to be most important for health out of a list of ten determinants. We stratified the results by income and urbanicity levels and tested significance of differences between groups using two-tailed χ tests. Multivariable logistic regression models tested associations between demographic factors and the likelihood of respondents selecting the genetics, healthcare, income and wealth, or social support determinants.
Here we show 8753 respondents across eight countries. Rankings of determinants are similar across income groups, except for two determinants. Respondents in the highest income group rank genetics in higher proportions (32.4%, 95%CI: 29.0%,35.8%) compared to other income groups. Conversely, those in lowest income group rank social support more frequently (27.9%, 95%CI: 25.3%,30.7%) than other income groups. Those living in urban settings rank healthcare in higher proportions (61.2%, 95%CI: 59.0%,63.4%) compared to non-urban respondents; meanwhile, higher proportions (26.6%, 95%CI: 24.9%,28.3%) of non-urban respondents rank social support as important for health compared to urban respondents.
Demographic factors play a role in shaping public views of what affects health. Advancing public understanding about determinants of health requires tailoring public health messaging to account for socioeconomic position within a population.
目前仍缺乏对公众对健康社会决定因素看法的清晰理解。本文旨在描述收入与城市化水平之间的关系，以及八个在多个特征方面存在差异的中高收入国家公众对健康决定因素的看法。
我们在巴西、中国、德国、埃及、印度、印度尼西亚、尼日利亚和美国进行了一项横断面在线调查。要求受访者从十个决定因素列表中选出他们认为对健康最重要的因素。我们按收入和城市化水平对结果进行分层，并使用双侧χ检验来检验组间差异的显著性。多变量逻辑回归模型检验了人口因素与受访者选择遗传、医疗保健、收入和财富或社会支持决定因素的可能性之间的关联。
我们展示了来自八个国家的8753名受访者的数据。除了两个决定因素外，各收入组对决定因素的排名相似。与其他收入组相比，最高收入组的受访者中认为遗传因素最重要的比例更高（32.4%，95%置信区间：29.0%，35.8%）。相反，最低收入组的受访者比其他收入组更频繁地将社会支持列为最重要因素（27.9%，95%置信区间：25.3%，30.7%）。与非城市受访者相比，居住在城市地区的受访者中认为医疗保健最重要的比例更高（61.2%，95%置信区间：59.0%，63.4%）；与此同时，与城市受访者相比，更高比例（26.6%，95%置信区间：24.9%，28.3%）的非城市受访者认为社会支持对健康很重要。
人口因素在塑造公众对影响健康因素的看法方面发挥着作用。增进公众对健康决定因素的理解需要根据人群中的社会经济地位来调整公共卫生信息。
