台湾老年人健康方面的社会经济不平等:生命历程视角
Socioeconomic inequalities in health among elderly people in Taiwan: A life course perspective.
作者信息
Tan Hsiao-Hsiao, Lee Yi-Chan, Chen Ya-Mei, Chiang Tung-Liang
机构信息
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
出版信息
PLoS One. 2025 Jul 3;20(7):e0327191. doi: 10.1371/journal.pone.0327191. eCollection 2025.
BACKGROUND
Individuals' health could be well predicted through their lifetime trajectories. Those with greater socioeconomic advantages tend to exhibit better health and a slower rate of health decline as they age, and vice versa.
OBJECTIVE
This study aims to investigate how health trajectory in old age is shaped by the accumulation of socioeconomic status (SES) across three life stages.
METHOD
The dataset used in this study is derived from the Taiwan Longitudinal Study on Aging (TLSA) conducted from 1989 to 2003, with 4,048 respondents aged 60 and older. A stratified analysis, utilizing Generalized Estimating Equations (GEE) models, is employed to investigate the interrelationships between SES across three life stages and the longitudinal patterns of three health outcomes.
RESULT
Of all the participants over the five waves, participants' health declined with aging, while the proportion of higher SES among remaining individuals tended to increase. A gradient in health improvements is observed, corresponding to the accumulation of SES, even after adjusting for demographic factors and baseline health. Moreover, improvements in a single SES indicator are significantly associated with better health when controlling for the other two indicators (all p < 0.01). This indicates an independent effect of each SES indicator. Additionally, SES tends to be inherited from preceding statuses. The interaction among all three SES indicators cannot be overlooked when considering the association between SES and health.
CONCLUSION
Health outcomes are shaped progressively and independently by each SES factor, with these effects being reinforced by the cumulative nature of SES. Policies aimed at enhancing later-life health are better implemented in early life stages. However, it is never too late, as each SES at different life stages has its own effect and cannot be offset.
背景
通过个体一生的轨迹能够很好地预测其健康状况。社会经济优势较大的个体往往表现出更好的健康状况,并且随着年龄增长健康下降速度较慢,反之亦然。
目的
本研究旨在探讨老年期的健康轨迹如何受到三个生命阶段社会经济地位(SES)积累的影响。
方法
本研究使用的数据集来自1989年至2003年进行的台湾老年纵向研究(TLSA),有4048名60岁及以上的受访者。采用分层分析,利用广义估计方程(GEE)模型,来研究三个生命阶段的SES与三种健康结果的纵向模式之间的相互关系。
结果
在所有五轮调查的参与者中,参与者的健康状况随着年龄增长而下降,而剩余个体中较高SES的比例趋于增加。即使在调整了人口因素和基线健康状况之后,仍观察到与SES积累相对应的健康改善梯度。此外,在控制其他两个指标时,单个SES指标的改善与更好的健康状况显著相关(所有p<0.01)。这表明每个SES指标都有独立的作用。此外,SES倾向于从前一状态继承。在考虑SES与健康之间的关联时,不能忽视所有三个SES指标之间的相互作用。
结论
健康结果由每个SES因素逐步独立塑造,这些影响因SES的累积性质而得到加强。旨在改善晚年健康的政策最好在生命早期阶段实施。然而,任何时候都不晚,因为不同生命阶段的每个SES都有其自身的作用且无法抵消。
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本文引用的文献
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Soc Sci Med. 2010-5-25