Mackenbach J P, Kunst A E
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
Soc Sci Med. 1997 Mar;44(6):757-71. doi: 10.1016/s0277-9536(96)00073-1.
In this paper we review the available summary measures for the magnitude of socio-economic inequalities in health. Measures which have been used differ in a number of important respects, including (1) the measurement of "relative" or "absolute" differences; (2) the measurement of an "effect" of lower socio-economic status, or of the "total impact" of socio-economic inequalities in health upon the health status of the population; (3) simple versus sophisticated measurement techniques. Based on this analysis of summary measures which have previously been applied, eight different classes of summary measures can be distinguished. Because measures of "total impact" can be further subdivided on the basis of their underlying assumptions, we finally arrive at 12 types of summary measure. Each of these has its merits, and choice of a particular type of summary measure will depend partly on technical considerations, partly on one's perspective on socio-economic inequalities in health. In practice, it will often be useful to compare the results of several summary measures. These principles are illustrated with two examples: one on trends in the magnitude of inequalities in mortality by occupational class in Finland, and one on trends in the magnitude of inequalities in self-reported morbidity by level of education in the Netherlands.
在本文中，我们回顾了现有的用于衡量健康方面社会经济不平等程度的汇总指标。已使用的指标在一些重要方面存在差异，包括：（1）“相对”或“绝对”差异的衡量；（2）社会经济地位较低的“影响”的衡量，或健康方面社会经济不平等对人群健康状况的“总体影响”的衡量；（3）简单与复杂的测量技术。基于对先前应用的汇总指标的分析，可以区分出八类不同的汇总指标。由于“总体影响”指标可根据其基本假设进一步细分，我们最终得出了12种汇总指标类型。每种类型都有其优点，选择特定类型的汇总指标部分取决于技术考量，部分取决于对健康方面社会经济不平等的观点。在实践中，比较几种汇总指标的结果往往是有用的。通过两个例子来说明这些原则：一个是关于芬兰按职业阶层划分的死亡率不平等程度的趋势，另一个是关于荷兰按教育水平划分的自我报告发病率不平等程度的趋势。
