Helmert U, Shea S
Division of Epidemiology, Bremen Institute for Prevention Research and Social Medicine (BIPS), Germany.
Public Health. 1994 Sep;108(5):341-56. doi: 10.1016/s0033-3506(05)80070-8.
To examine social class gradients for seven self-reported diseases in western Germany.
A pooled analysis of three cross-sectional representative health surveys in western Germany and three health surveys in the six intervention regions of the German Cardiovascular Prevention Study.
44,363 study subjects, of both sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991.
Assessment of disease prevalence was carried out by a standardized self-administered questionnaire. Social class was assessed using a composite index combining educational achievement, occupational status and household income. Cigarette smoking and Pattern A behaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of previous myocardial infarction and the prevalence of stroke, diabetes mellitus and chronic bronchitis was significantly higher in the lower social classes. In males only, the prevalence of intervertebral disc damage and peptic ulcer was significantly higher in the lower social classes. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseases with higher prevalence in the higher social classes. Adjusting these trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class gradients.
In western Germany, despite a health system with almost free access for the general population, strong social class inequalities exist for many diseases. These inequalities cannot be explained by social class differences in smoking, obesity or Pattern A behaviour. More research is needed to identify underlying causes for these persistent social inequalities in health status.
调查德国西部七种自我报告疾病的社会阶层梯度。
对德国西部三项横断面代表性健康调查以及德国心血管疾病预防研究六个干预地区的三项健康调查进行汇总分析。
1984年至1991年期间，在全国和地区健康调查中对44363名年龄在25至69岁之间、具有德国国籍的男女研究对象进行了检查。
通过标准化的自我管理问卷对疾病患病率进行评估。使用综合教育成就、职业地位和家庭收入的复合指数评估社会阶层。吸烟和A型行为基于自我报告。通过体格检查测量身高和体重，并计算体重指数。使用多元逻辑回归进行统计分析。全国调查的应答率在66.0%至71.4%之间，地区调查的应答率在65.9%至83.8%之间。对于男女两性而言，较低社会阶层中心肌梗死病史的患病率以及中风、糖尿病和慢性支气管炎的患病率显著更高。仅在男性中，较低社会阶层中椎间盘损伤和消化性溃疡的患病率显著更高。仅在女性中，高尿酸血症和痛风也存在类似的梯度。在男女两性中，过敏和花粉热是仅在较高社会阶层中患病率较高的疾病。对吸烟、肥胖和A型行为进行这些趋势调整后，特定疾病社会阶层梯度的斜率仅有微小变化。
在德国西部，尽管卫生系统对普通民众几乎免费，但许多疾病仍存在强烈的社会阶层不平等。这些不平等无法用吸烟、肥胖或A型行为的社会阶层差异来解释。需要更多研究来确定这些健康状况方面持续存在的社会不平等的潜在原因。
