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墨西哥老年人功能受限方面的健康不平等:一种交叉性方法。

Health inequities in functional limitation among Mexican older adults: An intersectional approach.

作者信息

García-Hernández Héctor, Salinas-Escudero Guillermo, Reyes-Morales Hortensia, Carrillo-Vega María Fernanda

机构信息

Health Research Division, National Institute of Geriatrics, Mexico City, Mexico.

Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

出版信息

PLoS One. 2025 Aug 5;20(8):e0325211. doi: 10.1371/journal.pone.0325211. eCollection 2025.

Abstract

Functional limitation represents a major health concern among older adults, with its incidence increased based on personal characteristics such as being a woman, having minor levels of education, and lower socioeconomic status, leading to health inequities. Addressing these inequities requires comprehensive frameworks like intersectionality to provide a broader perspective. This study analyzes health inequities in functional limitation among Mexican older adults using data from the 2021 round of the Mexican Health and Aging Study (MHAS) within an intersectional framework. The Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) technique, recognized as the gold standard in quantitative intersectionality research, was employed. Six variables were assessed: age, sex, education, social engagement, economic status, and access to health services. The results indicate that age, social engagement, and economic status were the main variables that explain functional limitation. Enhancing social engagement emerges as a practical short-term strategy to improve functionality and reduce inequities. Contrary to prior evidence, sex was not directly associated with functional limitation. Therefore, higher rates of functionality loss previously reported in the literature may not simply be linked to being a woman but rather to the societal implications of being a woman in contemporary contexts. Similarly, access to health services did not show a significant relationship with functional limitation despite the health system being a critical intermediate social determinant of health with the potential to address inequities. This research underscores the importance of intersectionality in understanding inequality, offering a nuanced perspective on overlapping systems of oppression and privilege to address disparities in Mexican older adults.

摘要

功能受限是老年人主要的健康问题,其发病率因个人特征(如女性、受教育程度低和社会经济地位低)而上升,导致健康不平等。解决这些不平等问题需要像交叉性理论这样的综合框架来提供更广阔的视角。本研究在交叉性框架内,使用2021年墨西哥健康与老龄化研究(MHAS)的数据,分析了墨西哥老年人功能受限方面的健康不平等情况。采用了个体异质性和歧视准确性多水平分析(MAIHDA)技术,该技术被认为是定量交叉性研究的金标准。评估了六个变量:年龄、性别、教育、社会参与、经济状况和获得医疗服务的机会。结果表明,年龄、社会参与和经济状况是解释功能受限的主要变量。加强社会参与是提高功能和减少不平等的一项切实可行的短期策略。与先前的证据相反,性别与功能受限没有直接关联。因此,文献中先前报道的较高功能丧失率可能不仅仅与女性身份有关,而是与当代背景下女性身份的社会影响有关。同样,尽管卫生系统是健康的关键中间社会决定因素,有潜力解决不平等问题,但获得医疗服务的机会与功能受限没有显著关系。这项研究强调了交叉性理论在理解不平等方面的重要性,为解决墨西哥老年人的差异问题提供了一个关于压迫和特权重叠系统的细致入微的视角。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca9d/12324098/bb44490ad689/pone.0325211.g001.jpg

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