儿童期社会经济地位与中老年健康状况的关系研究

发布时间：2018-06-13 08:43

本文选题：儿童期 + 社会经济地位　；参考：《山东大学》2014年博士论文

【摘要】：研究背景大量研究发现利用收入、教育或职业衡量的不同社会阶层中,健康是不平等分布的。早期关于健康的社会经济梯度的研究集中于阐述这些梯度的存在,很少去研究社会经济梯度背后的原因。理论模型和实证研究都致力于解释成年期出现健康差异的原因,但没有一个因素,无论是单独的还是结合的,能完全地解释健康的社会经济梯度。研究者认为,社会经济地位对健康的影响并非是一时的,而是持续的、累积的,人生早期的生活经历会对未来健康产生长远的影响。在生命周期的各个阶段中,儿童期非常关键。儿童期的社会经济地位以及生活环境对成年期社会经济地位以及疾病风险有着长期的影响,这种影响将可能持续一生。近年来研究者开始关注儿童期的社会经济地位与成年期健康以及长寿的关系,致力于从源头探究健康差异。现有的相关研究主要集中在欧美等发达国家,来自发展中国家的研究非常有限。多数研究的健康指标集中在死亡率以及心血管疾病,部分文献利用了比较单一的健康指标如自评健康、认知功能等,全面综合地从生理、心理等方面评价中老年人健康状况的研究较少,并且在使用不同的指标以及在不同地区的人群中开展研究的时候,得出的结论并不一致。我国作为发展中国家,社会经济水平、人们的健康状况、行为生活方式和发达国家相比都存在较大差异。并且,我国中老年人的生活轨迹可能更为复杂,不可避免地会影响到中老年群体的儿童期及当前的社会经济地位,进而对健康状况造成影响。研究目的本研究的总目标是通过理论研究和实证分析,探讨儿童期社会经济地位与中老年健康的关系以及生命历程里社会经济地位的变动对中老年健康状况的影响,为减少健康差异、促进健康公平政策的制定提供理论基础和科学依据。具体研究目的包括：构建儿童期社会经济地位与中老年健康关系的理论和实证模型；揭示儿童期社会经济地位与中老年自评健康、日常活动能力、认知功能、抑郁症状等健康指标之间的关系；探讨社会经济地位的变动对中老年健康状况的影响；分析儿童期社会经济地位、儿童期健康、中老年期社会经济地位及中老年健康之间的相互关系；提出减少健康差异、促进健康公平的政策建议。研究方法本研究数据来源于“中国健康与养老追踪调查(CHARLS)"2011-2012年全国基线调查,CHARLS的抽样方法为多阶段分层概率比例规模抽样。最终抽取28个省(直辖市),150个县(区),450个行政村(社区),本文的研究对象为参与问卷调查及体检的45岁及以上的中老年人,删除关键变量缺失及异常值的样本,本研究最终纳入的家户数为8520,样本量为13516。在分析方法上,本研究首先对样本的基本情况以及社会经济特征进行了描述和比较；然后利用单因素和多因素分析探讨了儿童期社会经济地位与不同健康指标的关系,通过构建Logistic回归模型,在模型中逐步纳入儿童期社会经济地位、儿童期健康、中老年期社会经济地位,分析逐步控制上述因素后模型的变化；随后通过主成分分析构建儿童期社会经济地位及中老年期社会经济的综合指标,分析生命历程里社会经济地位的变动与健康状况的关系；最后是构建PLS路径分析模型,探讨了儿童期社会经济地位、儿童期健康、中老年期社会经济地位以及不同健康指标之间的关系。资料的统计分析由SPSS16.0软件和Smart PLS2.0软件完成。主要研究结果 (1)儿童期社会经济地位与中老年健康状况的关系研究对象自评健康为很好、好、一般、不好、很不好的比例分别为6.9%、15.3%、47.7%、27.4%和2.6%,日常活动能力的受损率为16.8%,抑郁症状的发生率为37.7%,高血压的患病率为40.9%,认知均分为12.73分。除了高血压患病之外,单因素分析均显示,儿童期SES处于劣势的研究对象,中老年期的健康状况较差。在多因素分析中,控制了中老年当前的SES之后,儿童期SES与自评健康、日常活动能力受损、抑郁症状以及高血压患病的关系消失,但与认知功能的关系存在统计学意义,儿童期居住于城镇、父母亲接受过教育的研究对象,中老年期的认知功能更好。 (2)儿童期到中老年期社会经济地位的变动与中老年健康状况的关系研究对象的年龄、婚姻状况以及地区不同,儿童期SES综合得分存在差异(P0.001),低龄、在婚、东中部的研究对象,儿童期SES综合得分较高；研究对象的性别、年龄、婚姻状况以及地区不同,中老年期SES的综合得分存在差异(P0.001),男性、低龄、在婚、东部的研究对象,中老年期SES的综合得分较高。研究对象从儿童期到中老年期SES的变动“保持低水平”、“由高到低”、“由低到高”、“保持高水平”的比例分别为37.4%、12.6%、21.6%和28.4%。低龄组、在婚组“保持高水平”的比例更高,和男性相比,女性的社会经济地位更难上升。SES变动形式不同,自评健康不良率、ADL受损率、高血压患病率、抑郁症状发生率、认知功能均存在统计学差异。儿童期SES较低但经历了SES上升的研究对象与SES未经历上升的相比,健康状况更好；相反,儿童期SES较高但后期经历了SES下降的研究对象与未经历SES下降的相比,健康状况更差。但高血压患病未呈现类似的变化趋势,SES“保持高水平”的研究对象高血压患病风险最高,“保持低水平”的患病风险最低。 (3)儿童期社会经济地位与中老年健康关系的路径分析所有的PLS路径模型均显示,儿童期SES与中老年SES的标准化路径系数最大,儿童期SES越高,中老年期SES越高；儿童期SES越高,儿童期健康状况越好；儿童期健康状况越好,中老年SES越高；中老年SES越高,自评健康越好,日常活动能力受损越小,抑郁症状发生风险越低,认知功能越好。儿童期SES与不同健康指标的关系有差异,儿童期SES对中老年认知具有直接影响,儿童期SES越高,中老年期认知功能越好,但与其他健康指标的关系,未见统计学意义,儿童期SES与其他健康指标的关系更多是通过儿童期健康及中老年SES的间接作用。另外,儿童期健康与不同健康指标的关系也有差异,儿童期健康状况越好,中老年自评健康越好,抑郁症状发生风险越低,但与ADL、高血压患病以及认知功能的关系未见统计学意义。结论及建议根据研究结果,本研究得出如下结论： (1)儿童期SES对中老年健康具有长远的影响,儿童期SES处于劣势,会增加中老年健康状况不良的风险。但对于不同的健康指标,这种关系的强度不一样,对于自评健康、日常活动能力、高血压患病和抑郁症状,主要是通过儿童期健康及中老年当前的社会经济地位发挥中介作用,证实了“路径模型”；对于认知功能,则更多体现了儿童期SES直接的作用,证实了“累积劣势模型”。(2)儿童期到中老年期SES上移,能部分补偿儿童期不良SES的负面影响,儿童期到中老年期SES下移,早期良好SES的影响会被下移的SES所抵消。(3)儿童期SES处于劣势的研究对象,中老年期SES更为低下。社会经济地位具有代际转移的特点,证实了“地位获得模型”。(4)儿童期健康状况不良的研究对象,中老年期SES更为低下,体现在受教育程度和家庭人均收入较低,验证了“健康选择学说”。(5)儿童期健康状况不良,中老年期的自评健康较差,日常活动能力和抑郁症状发生率较高,人生早期的健康状况产生长远影响,甚至持续终身。(6)研究对象当前的社会经济地位对健康具有重要影响。现居地为农村、受教育程度低、家庭人均收入低的研究对象,自评健康状况较差,日常活动能力受损较严重,抑郁症状发生率较高,认知功能较为低下。因此,缩小社会经济地位的差异有助于降低健康不平等。上述结论具有如下政策含义(1)重视儿童期社会经济地位对整个生命历程的长远影响,将儿童期作为生命历程里降低健康差异的最佳时机。缩小社会经济地位的差异,不仅能缩小当前的健康差异,而且对未来健康产生潜在的长远影响。(2)改善健康状况,促进健康公平,不仅仅依赖于个人当前的社会经济地位或卫生服务因素,还有赖于早期的生活经历和健康状况。意味着完善卫生系统内的举措只是解决卫生服务本身的问题,要增进健康,促进公平,不仅需要相对完善的卫生服务,更需着力破解卫生系统之外的诸多问题。要将其置于一个宏观的社会经济制度的框架下综合考虑,注重缩小城乡社会经济差异、教育差异。创新与不足本研究的创新性(1)现有的关于儿童期社会经济地位与成年健康的研究主要集中在欧美国家,本研究利用我国大规模的调研数据,基于生命历程理论,从生理、心理、认知功能等方面全面探讨儿童期社会经济地位与中老年健康状况的关系,提供来自我国的证据。(2)通过构建综合性的社会经济地位指标,探讨了生命历程里社会经济地位的变动对健康状况的影响,弥补了国内该方面研究的不足。(3)构建PLS路径分析模型,对儿童期SES、儿童期健康、中老年SES以及中老年健康之间的关系进行了系统分析,有利于为减小健康差异、促进公平的政策制定找到干预点。本研究的不足(1)只掌握了有限的儿童期信息,儿童期到中老年的时间跨度大,且利用的是横断面数据,本研究只是对儿童期社会经济地位与中老年健康之间的关系进行了探讨,难以确定因果关系的方向。(2)对于儿童期社会经济地位低下的个体来说,可能在进入中年之前就已经去世,被排除在本研究的样本之外,可能导致一定的样本选择偏倚。(3)社会经济地位的测量只包括两个时点,而出生时的情况及中期之前的工作收入等都有可能影响健康状况,由于数据的限制,并未考虑这一影响,有可能影响研究结论。
[Abstract]:Background of the study

A large number of studies have found that health is not equally distributed among different social strata measured by income , education or occupation . Early research on healthy socio - economic gradients focuses on explaining the causes of health disparities in adulthood , but there is no one factor , whether alone or in combination , a long - term impact on the future health . In all stages of the life cycle , children ' s life is critical . The socio - economic status of the children ' s period and the life environment have a long - term impact on the socio - economic status of adulthood and the risk of disease .

In recent years , researchers have focused on the relationship between the socio - economic status of childhood and the health of adulthood and long - life , and are committed to exploring health differences from the source . The existing research focuses mainly on developed countries such as Europe and America , and the conclusions are not consistent . In China , as a developing country , social and economic levels , people ' s health status , behavioral life style and developed countries , there are significant differences .

Purpose of study

The main objective of this study is to study the relationship between the social and economic status of childhood and the health of middle - aged and old - aged and old people through theoretical research and empirical analysis , and to provide theoretical basis and scientific basis for the development of health equity policy in order to reduce health disparities and promote healthy and fair policies .

The purpose of this study is to build a theoretical and empirical model of the relationship between the social and economic status of childhood and the healthy relationship between the aged and the aged ;
To reveal the relationship between the socio - economic status of childhood and the health indicators , such as health , daily activity , cognitive function and depression .
To explore the influence of changes of socioeconomic status on health status of middle - aged and old people ;
To analyze the relationship between the social and economic status of childhood , the children ' s health , the socioeconomic status of the middle and old age and the health of middle - aged and aged people ;
A policy proposal to reduce health disparities and promote healthy and equitable health is proposed .

Research Methods

The data of this study was derived from the National Baseline Survey of China ' s Health and Old Age Trace ( CHARLS ) 2011 - 2012 . The sampling method of CHARLS is the sampling of multi - stage stratified probability scale . In the end , 28 provinces ( municipalities directly under the Central Government ) , 150 counties ( districts ) and 450 administrative villages ( communities ) are drawn . The study objects in this paper are samples of middle - aged and old people aged 45 and above who participate in the questionnaire and physical examination , delete the missing and abnormal values of key variables , and the total number of households in this study is 8520 , and the sample size is 13516 . Based on the analysis method , the basic condition of the sample and the social and economic characteristics are described and compared . Then , the relationship between the socioeconomic status of childhood and the different health indicators is discussed by means of single factor and multi - factor analysis . The relationship between the change of social and economic status and the health status in the life course is analyzed by constructing the Logistic regression model . Finally , the relationship between the social and economic status , the children ' s health , the social and economic status of the middle and the old age and the different health indicators is analyzed through the analysis of principal component . The statistical analysis of the data is completed by SPSS 16.0 software and Smart PLS2 . 0 software . Primary Study Results ( 1 ) Relationship between socio - economic status and health status of middle - aged and aged people in childhood In addition to the prevalence of hypertension , SES and self - assessment health , the prevalence of depressive symptoms and hypertension were 40.9 % , 15.3 % , 47.7 % , 27.5 % and 2.6 % , respectively . ( 2 ) The relationship between the changes of social economic status and the health status of middle - aged and old age in childhood to middle and old age The age , marital status and difference of SES in children were different ( P0.001 ) , low age , early marriage and middle aged SES , and the comprehensive score of SES in children was higher . The proportion of SES changed from childhood to mid - aged SES was higher than that of male , and the proportion of female ' s social and economic status was higher than that of men . The proportion of SES varied , self - rating health bad rate , ADL vulnerability , hypertension prevalence , depression incidence and cognitive function were statistically different .
In contrast , there was a higher incidence of SES in children with SES but a worse health condition compared to those who did not experience a decline in SES . However , hypertension did not exhibit similar trends , and SES " maintained a high level " of study subjects had the highest risk of hypertension and the lowest risk of " maintaining a low level " .

( 3 ) Path analysis of the relationship between socio - economic status and health of middle - aged and old people in childhood

All PLS path models show that the standardized pathway coefficients of SES and SES in children are the largest , the higher the SES of SES , the higher the SES of SES .
The higher the children ' s SES , the better the children ' s health status ;
The better the children ' s health status , the higher the SES of middle - aged and old - aged SES ;
Compared with other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the children ' s health status , the better the self - assessment health of middle - aged and old age , the lower the risk of depressive symptoms , but no statistical significance with ADL , hypertension and cognitive function .

Conclusions and recommendations

Based on the results of the study , this study concludes with the following conclusions :

( 1 ) Children ' s SES has a long - term effect on the health of middle - aged and old people , and SES is at a disadvantage in childhood , which can increase the risk of poor health status of middle - aged and old people . But for different health indicators , the intensity of this relationship is different . For self - evaluation health , daily activity , hypertension and depression , the " path model " is confirmed mainly through the intermediary role of current social and economic status of childhood health and middle - aged and old age .
( 3 ) Children ' s period to middle and old age SES moves upward , can partially compensate for children ' s bad SES ' s negative effect , children ' s period to middle and old age SES moves down , the influence of early good SES can be offset by SES . ( 3 ) Children ' s age health is bad , middle and old age SES is lower , the incidence of daily activity ability and depressive symptoms is low , the incidence of self - assessment is worse , the daily activity ability is damaged , depression symptom is high , cognitive function is low . Therefore , the difference between social and economic status helps to reduce health inequality .

The conclusion is as follows : ( 1 ) Pay attention to the long - term impact of the social and economic status of childhood on the whole life course , and reduce the children ' s life as the best time to reduce the health difference in the course of life .

Innovation and deficiency

Based on the theory of life history , the relationship between social and economic status of childhood and the health status of middle - aged and old people is discussed comprehensively on the basis of life history theory .

It is difficult to determine the direction of causality . ( 2 ) For individuals with low socio - economic status , it is difficult to determine the direction of causality . ( 2 ) For individuals with low socioeconomic status , it may lead to some sample selection bias .
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R179;R592

【参考文献】