Race, socioeconomic status, and cause-specific mortality

PURPOSE: Life expectancy for black Americans is five to eight years less than for Whites. The socioeconomic status (SES) of Blacks is also less than for Whites, and SES is associated with early mortality. This paper estimates the proportion of the racial difference in mortality attributable to SES by specific causes of death. METHODS: Data on 453,384 individuals in the National Longitudinal Mortality Study were used to estimate the hazard ratio associated with black race, with and without adjustment for income and education (measures of SES), in 38 strata defined by cause of death and age. RESULTS: For women, SES accounted for much (37-67%) of the black excess mortality for accidents, ischemic heart disease (ages 35-54), diabetes, and homicide; but not for hypertension, infections, and stomach cancers (11-17%). For men, SES accounted for much of the excess risk (30-55%) for accidents, lung cancer, stomach cancer, stroke, and homicide; but not for prostate cancer, pulmonary diseases, hypertension, and cardiomyopathy (0-17%). CONCLUSIONS: These results confirm those specific causes of death likely to underlie the overall excess mortality of Blacks, and identify those causes where SES may play a large role.     

Serum lycopene,other serum carotenoids,and risk of prostate cancer in US Blacks and Whites

Epidemiologic studies investigating the relation between individual carotenoids and risk of prostate cancer have produced inconsistent results. To further explore these associations and to search for reasons prostate cancer incidence is over 50% higher in US Blacks than Whites, the authors analyzed the serum levels of individual carotenoids in 209 cases and 228 controls in a US multicenter, population-based case-control study (1986-1989) that included comparable numbers of Black men and White men aged 40-79 years. Lycopene was inversely associated with prostate cancer risk (comparing highest with lowest quartiles, odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.36, 1.15; test for trend, p = 0.09), particularly for aggressive disease (comparing extreme quartiles, OR = 0.37, 95% CI: 0.15, 0.94; test for trend, p = 0.04). Other carotenoids were positively associated with risk. For all carotenoids, patterns were similar for Blacks and Whites. However, in both the controls and the Third National Health and Nutrition Examination Survey, serum lycopene concentrations were significantly lower in Blacks than in Whites, raising the possibility that differences in lycopene exposure may contribute to the racial disparity in incidence. In conclusion, the results, though not statistically significant, suggest that serum lycopene is inversely related to prostate cancer risk in US Blacks and Whites.     

Roles of religious involvement and social support in the risk of colon cancer among Blacks and Whites

This population-based case-control study of Blacks and Whites in North Carolina (1996-2000) examined the relation between social ties, etiology of colon cancer, and stage of disease at diagnosis. Interviews were conducted with 637 cases and 1,043 controls. Information was collected on two dimensions of social ties, structural (network) dimensions and functional (emotional and tangible help) dimensions. Infrequent attendance at religious services (less than once per month) was associated with a regional/advanced stage of colon cancer at diagnosis in Whites (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.09, 2.57; p for trend = 0.02) but not in Blacks (OR = 1.21, 95% CI: 0.66, 2.21; p for trend = 0.80). Among Blacks, minimal emotional support was strongly associated with risk of colon cancer (OR = 4.62, 95% CI: 2.06, 10.35; p for trend < 0.001) and with both local (OR = 3.69, 95% CI: 1.08, 12.69; p for trend < 0.001) and advanced (OR = 5.10, 95% CI: 2.03, 12.82; p for trend < 0.01) disease. No associations between emotional support and risk of colon cancer or stage of disease were observed among Whites. These results suggest that certain characteristics of social ties are associated with both risk of and prognostic indicators for colon cancer.     

Socioeconomic status and lung cancer risk in Canada

BACKGROUND: Several epidemiological studies have found that lung cancer is inversely related to socioeconomic status (SES) and suggest it as a possible risk factor for lung cancer. This study examines SES and lung cancer risk in Canada. METHODS: Mailed questionnaires with telephone follow-up were used to obtain data on 3280 newly diagnosed, histologically confirmed lung cancer cases and 5073 population controls, between 1994 and 1997, in eight Canadian provinces. Measurement included information on SES, smoking habits, alcohol use, diet, residential and occupational histories and both residential and occupational exposure to environmental tobacco smoke (ETS). Odds ratios (OR) and 95% CI were derived from unconditional logistic regression analysis. RESULTS: Compared with high income adequacy, an increased risk was found among low income males and females, with adjusted OR of 1.7 (95% CI : 1.3-2.2) and 1.5 (95% CI : 1.1-2.0), respectively. Compared with < or = 8 years of education, the adjusted OR were 0.6 (95% CI : 0.5-0.7) and 0.6 (95% CI : 0.5-0.8) for > or = 14 years education among males and females, respectively. Lung cancer risk was significantly increased for males of some social classes. The population attributable risk for income adequacy, education and social class was 24%, 25% and 21% among males, respectively, and 14% and 19% for income adequacy and education among females, respectively, in this Canadian population. CONCLUSIONS: A statistically significant association between income adequacy, education social class and lung cancer risk was found.     

Childhood social and economic well-being and health in older age

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants' mean age was 67 years; 57% were women. By race/ethnicity, 76% were White, 14% were Black, and 8% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95% CI: 1.21, 1.47) and Black (AOR = 1.37, 95% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.     

Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension

The association between socio-economic status (SES) and untreated hypertension varies according to a country's level of development and racial/ethnic group. We sought to confirm this variation in women from China and the United States (US) as well as to investigate the impact of SES on several mediating risk factors. We also investigate the extent to which SES explains racial/ethnic differences in untreated hypertension in the US. We used cross-sectional data from 1814 non-pregnant women in China (China Health and Nutrition Survey (CHNS), 1997) and 3266 non-pregnant women in the United States (National Health and Nutrition Examination Survey (NHANES III), 1988-1994) respectively. A variety of statistical modelling techniques was used to predict untreated hypertension as a function of several mediating factors and to simulate the impact of changes in SES. The age-adjusted prevalence of untreated hypertension was significantly higher (p<0.01) for low-income White and Black women compared to Mexican American or Chinese women. Untreated hypertension was not significantly associated with income or education in Mexican Americans or women in China. Obesity and light physical activity had the largest mediating effect on the association between SES and untreated hypertension for all racial/ethnic groups. However, this effect was not as strong as the proxy effect of income and education. SES did not completely explain racial/ethnic differences in hypertension in the US. While SES was more strongly associated with hypertension in Blacks than Whites, Blacks were still 1.97 (95% CI 1.47-2.64) times more likely to have untreated hypertension than Whites after adjusting for SES differences. The association between SES and untreated hypertension varied by country and racial/ethnic group. An important explanation for this variation was the differential effect of SES on mediating risk factors. SES disparities between Whites and Blacks in the US partly explain differences in the prevalence of untreated hypertension between these racial/ethnic groups.     

Incidence of hypertension and educational attainment: the NHANES I epidemiologic followup study. First National Health and Nutrition Examination Survey

Previous research has demonstrated the association between cardiovascular disease and education. However, few studies have described the incidence of hypertension, a risk factor for cardiovascular disease, by education or other socioeconomic status indicators. To examine the association between hypertension incidence and education, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Followup Study (NHEFS) (1971-1984). The relative risk of hypertension incidence (blood pressure > or =160/95 and/or using antihypertensive medication) by education was calculated for non-Hispanic Whites (aged 25-64 years) and non-Hispanic Blacks (aged 25-44 years) normotensive at baseline using Cox proportional hazards models. The age-adjusted relative risk of hypertension incidence among persons with less than 12 years of education compared with those with more than 12 years was significant among non-Hispanic Whites aged 25-44 years (men: relative risk (RR) = 2.14, 95% confidence interval (CI): 1.29, 3.54; women: RR = 2.06, 95% CI: 1.39, 3.05) but not among non-Hispanic Blacks (RR = 1.16, 95% CI: 0.63, 2.14). Relative risks for non-Hispanic White men remained stable after adjusting for age, systolic blood pressure, body mass index, and region of residence; relative risks for non-Hispanic White women were reduced but remained significant. Non-Hispanic White men and women aged 45-64 years with less than 12 years of education were not at higher risk of developing hypertension compared with their more educated counterparts. These results demonstrate a significant interaction between age and education with an independent association between education and hypertension incidence among younger but not older non-Hispanic White men and women.     

Work activities and the risk of multiple myeloma. A case-control study

The incidence of multiple myeloma is increasing in western countries, and several environmental and occupational risk factors have been suggested to explain this trend. A case-control study was conducted in order to investigate the relationship between occupation, exposure to chemicals, and risk of multiple myeloma. A total of 170 cases of multiple myeloma, 98 males and 72 females, aged 43-84 (mean age = 67 D.S. = 10), and 170 matched hospital controls (mean age = 68 D.S. = 9) were identified for the years 1970-1988. All subjects were interviewed about socioeconomic status, current or previous occupation, and if they had ever been exposed to one or more of a list of toxic substances. Exposure were grouped in 21 risk categories. Poor socioeconomic status was associated with a significant risk for multiple myeloma (OR = 2.8; 95% Confidence Interval: 1.61-3.05), as well as agricultural work (OR = 2.71; 95% CI: 1.87-4.42), and work in industry (OR = 3.20; 95% CI: 2.00-5.75). Regarding toxic substance exposure, a significant association was found for asbestos (OR = 4.00; 95% CI: 2.02-8.05), mineral oils (OR = 3.00; 95% CI: 1.98-5.08), pesticides (OR = 2.83; 95% CI: 1.87-4.78), and radiation (OR = 9.00; 95% CI: 0.81-21.73). No significant association was demonstrated for alcohol intake and tobacco smoking. High odds ratios were also found for fertilizers, paints, cosmetics and/or hairdressing products, and dust. These findings agree with previously reported studies, suggesting a relationship between some occupational exposures and the risk of multiple myeloma. The data, however, require clarification in prospective, larger, population-based studies.     

The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study

There has been recent interest in determining whether neighborhood characteristics are related to the cardiovascular health of residents. However, there are no data regarding the relationship between neighborhood socioeconomic status (SES) and prevalence of subclinical cardiovascular disease (CVD) in the elderly. We related personal SES (education, income, and occupation type) and neighborhood socioeconomic characteristics (a block-group score summing six variables reflecting neighborhood income and wealth, education, and occupation) to the prevalence of subclinical CVD (asymptomatic peripheral vascular disease or carotid atherosclerosis, electrocardiogram or echocardiogram abnormalities, and/or positive responses to Rose Questionnaire claudication or angina pectoris) among 3545 persons aged 65 and over, without prevalent CVD, in the Cardiovascular Health Study. Sixty percent of participants had at least one indicator of subclinical disease. Compared to those without, those with subclinical disease had significantly lower education, income, and neighborhood scores and were more likely to have blue-collar jobs. After adjustment for age, gender, and race, those in the lowest SES groups had increased prevalence of subclinical disease compared with those in the highest SES groups (OR = 1.50; 95% CI 1.21, 1.86 for income; OR = 1.41; 95% CI 1.18, 1.69 for education; OR = 1.39; 95% CI 1.16, 1.67 for block-group score). Those reporting a blue-collar lifetime occupation had greater prevalence of subclinical disease relative to those reporting a white-collar occupation (OR = 1.29; 95% CI 1.02-1.59). After adjustment for behavioral and biomedical risk factors, all of these associations were reduced. Neighborhood score tended to remain inversely associated with subclinical disease after adjustment for personal socioeconomic indicators but associations were not statistically significant. Personal income and blue-collar occupation remained significantly associated with subclinical disease after simultaneous adjustment for neighborhood score and education. Personal and neighborhood socioeconomic indicators were associated with subclinical disease prevalence in this elderly cohort. These relationships were reduced after controlling for traditional CVD risk factors.     

Trends in the sensitivity, positive predictive value, false-positive rate, and comparability ratio of hospital discharge diagnosis codes for acute myocardial infarction in four US communities, 1987-2000

Variations in the validity of hospital discharge diagnoses can complicate the assessment of trends in incidence of acute myocardial infarction (AMI). To clarify trends in the validity of discharge codes, the authors compared event classification based on published Atherosclerosis Risk in Communities (ARIC) Study criteria with the presence or absence of an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge code for AMI (code 410). Between 1987 and 2000, 154,836 coronary heart disease events involving hospitalization in the four ARIC communities had ICD-9-CM codes screened for AMI. The sensitivity of ICD-9-CM code 410 for classifying AMI in men (sensitivity = 0.65, 95% confidence interval (CI): 0.63, 0.66) was statistically significantly greater than that found for women (sensitivity = 0.60, 95% CI: 0.58, 0.62) and was greater in Whites (sensitivity = 0.67, 95% CI: 0.65, 0.68) than in Blacks (sensitivity = 0.50, 95% CI: 0.47, 0.53). The ethnic difference was related to a greater frequency of hypertensive heart disease and congestive heart failure codes encompassing AMI among Blacks as compared with Whites. The authors found that although the validity of ICD-9-CM code 410 to identify AMI was generally stable from 1987 through 2000, differences between Blacks and Whites and across geographic locations support investment in validation efforts in ongoing surveillance studies.     

Intimate partner violence and depression among Whites, Blacks, and Hispanics

PURPOSE: To examine the relationship between intimate partner violence and depression. METHODS: A household probability sample of Whites (n=616), Blacks (n=377), and Hispanics (n=592) age 18 or older was interviewed in 1995. The response rate was 85%. Logistic analysis is used to identify predictors of depression. RESULTS: Among men, Black (OR=.29; 95% CI, 0.13-.65) and Hispanic (OR=0.4; 95% CI, 0.2-0.8) ethnicity were protective against depression. Factors of risk for men included victimization by female to male partner violence (OR=4.04; 95% CI, 1.15-14.11), unemployment (OR=7.65; 95% CI, 1.59-16.39), and living in a high-unemployment neighborhood (OR=4.6; 95% CI, 1.86-11.37). Among women, the predictors are perpetration of moderate (OR=4.08; 95% CI, 1.33-12.47) or severe (OR=6.57; 95% CI, 1.76-24.52) female to male partner violence, and impulsivity (OR=1.82; 95% CI, 3.87-20.71). CONCLUSIONS: Knowledge from surveys using general population samples is important for developing prevention interventions in the community. Because predictors of depression in these samples are both individual and contextual at neighborhood level, prevention interventions to be effective must address not only individual factors of risk but also structural conditions in the environment where individuals live.     

Very-low-birthweight infants and income incongruity among African American and white parents in Chicago.

OBJECTIVES: Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight. METHODS: Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status. RESULTS: The odds ratios of very low birthweight for African Americans (n = 44,266) and Whites (n = 27,139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively. CONCLUSIONS: Positive income incongruity is associated with lower race-specific rates of very low birthweight.     

Depression in black and white women : The role of marriage and socioeconomic status

The degree to which the relationship between race and depression in US black and white women is modified by socioecanomic and marital status was investigated. Data on 534 black and 836 white women, 25 to 64 years old, obtained from the 1986 Americans' Changing Lives national survey were utilized. Depression was measured by the Centers for Epidemiologic Studies Depression scale. Poverty status and education were used as indicators of socioeconomic status (SES). For both black and white women, the prevalence of depression was higher among those with lower as compared to higher SES, and among the unmarried as compared to the married. The unstratified, age-adjusted odds of depression for black women was twice that for white women (odds ratio (OR) = 2.2; 95% confidence interval (CI), 1.7 to 2.8); however, when stratified by poverty status, race effects were observed for nonpoor (OR = 2.2; 95% CI, 1.6 to 3.0) but not for poor women (OR = 1.3; 95% CI, 0.7 to 2.1). Race effects were also more pronounced among married (OR = 2.0; 95% CI, 1.4 to 2.9) than unmarried women (OR = 1.6; 95% CI, 1.1 to 2.4). Controlling for known confounders did not alter these results. Additional analyses revealed that the black excess risk for depression was concentrated among higher SES, married women, with marital difficulties appearing to pay a major role in their elevated depression scores.     

Blacks’ Diminished Health Return of Family Structure and Socioeconomic Status; 15 Years of Follow-up of a National Urban Sample of Youth

The protective effect of family structure and socioeconomic status (SES) on physical and mental health is well established. There are reports, however, documenting a smaller return of SES among Blacks compared to Whites, also known as Blacks’ diminished return. Using a national sample, this study investigated race by gender differences in the effects of family structure and family SES on subsequent body mass index (BMI) over a 15-year period. This 15-year longitudinal study used data from the Fragile Families and Child Wellbeing Study (FFCWS), in-home survey. This study followed 1781 youth from birth to age 15. The sample was composed of White males (n = 241, 13.5%), White females (n = 224, 12.6%), Black males (n = 667, 37.5%), and Black females (n = 649, 36.4%). Family structure and family SES (maternal education and income to need ratio) at birth were the independent variables. BMI at age 15 was the outcome. Race and gender were the moderators. Linear regression models were run in the pooled sample, in addition to race by gender groups. In the pooled sample, married parents, more maternal education, and income to need ratio were all protective against high BMI of youth at 15 years of age. Race interacted with family structure, maternal education, and income to need ratio on BMI, indicating smaller effects for Blacks compared to Whites. Gender did not interact with SES indicators on BMI. Race by gender stratified regressions showed the most consistent associations between family SES and future BMI for White females followed by White males. Family structure, maternal education, and income to need ratio were not associated with lower BMI in Black males or females. The health gain received from family economic resources over time is smaller for male and female Black youth than for male and female White youth. Equalizing access to economic resources may not be enough to eliminate health disparities in obesity. Policies should address qualitative differences in the lives of Whites and Blacks which result in diminished health returns with similar SES resources. Policies should address structural and societal barriers that hold Blacks against translation of their SES resources to health outcomes.     

Socioeconomic Status,Race, and Mortality: A Prospective Cohort Study

Objectives. We evaluated the independent and joint effects of race, individual socioeconomic status (SES), and neighborhood SES on mortality risk.Methods. We conducted a prospective analysis involving 52 965 non-Hispanic Black and 23 592 non-Hispanic White adults taking part in the Southern Community Cohort Study. Cox proportional hazards modeling was used to determine associations of race and SES with all-cause and cause-specific mortality.Results. In our cohort, wherein Blacks and Whites had similar individual SES, Blacks were less likely than Whites to die during the follow-up period (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.73, 0.84). Low household income was a strong predictor of all-cause mortality among both Blacks and Whites (HR = 1.76; 95% CI = 1.45, 2.12). Being in the lowest (vs highest) category with respect to both individual and neighborhood SES was associated with a nearly 3-fold increase in all-cause mortality risk (HR = 2.76; 95% CI = 1.99, 3.84). There was no significant mortality-related interaction between individual SES and neighborhood SES among either Blacks or Whites.Conclusions. SES is a strong predictor of premature mortality, and the independent associations of individual SES and neighborhood SES with mortality risk are similar for Blacks and Whites.From birth through approximately age 85 years, there is a mortality rate disparity between Blacks and Whites in the United States that peaks in early adulthood and slowly narrows thereafter.1–4 Most of the excess deaths among Blacks occur in middle-aged adults, given the confluence of rising mortality rates and the disparity at those ages. During much of the 20th century, this disparity was unyielding,4–6 but recent data point to some narrowing of the gap beginning in the 1990s.7–9 Still, in 2011 the highest age-standardized death rate in the United States was that among non-Hispanic Blacks (877.4 per 100 000 standard population), followed by non-Hispanic Whites (738.1 per 100 000 standard population).10 Also, average life expectancies at birth in 2011 were 4.5 years shorter for Black than White men and 3.1 years shorter for Black than White women.10Although national mortality data are routinely reported by race/ethnicity, their interpretation must consider the determinants of race-specific mortality rates, including behavioral, social, economic, and political factors that determine the resources available to maintain health and prolong life.3 Whether socioeconomic status (SES) completely accounts for mortality differences between Blacks and Whites is not clear. Previous studies have reported that SES alone cannot fully account for the disparity, although in settings where Blacks and Whites are drawn from considerably different SES strata, confounding by SES may be difficult to overcome.11–14 By contrast, in settings where race-specific SES differences are minimal (including the current study), it has been suggested that important health indicators are quite similar by race.15–17 Individual-level SES aside, neighborhood-level SES has also been reported to influence mortality rates,18 but fewer investigations have assessed the joint contribution of individual and neighborhood SES,19–22 and analyses assessing the interplay of these 2 SES domains with race are rare.19,21We thus took the opportunity, within a large prospective study of non-Hispanic Black and White adults (residing in a large area of the United States, enrolled mainly in low-income settings but also non-low-income settings, and representing a range of SES levels), to evaluate the independent and joint contributions of race, individual SES, and neighborhood SES to overall and cause-specific mortality risk.     

Socioeconomic status and risk of multiple myeloma.

A case control study was conducted to test the hypothesis that socioeconomic status is positively associated with multiple myeloma incidence. One hundred and fifty-three myeloma cases and 459 controls were identified at the Duke University Medical Center at Durham, North Carolina. Study members were interviewed regarding indicators of socioeconomic status. The association of myeloma with family income (current and highest), education, occupation, home ownership, dwelling size, and an index of crowding in the home was examined by estimating relative risks. Among these indicators, only home ownership showed any association with multiple myeloma incidence (RR = 1.6, 95% CI: 1.0-2.6). The association of multiple myeloma with socioeconomic status that has been seen in earlier studies may have been due to underascertainment of disease in less advantaged groups. This association is disappearing as access to health care becomes more uniform across socioeconomic groups.     

Income is a stronger predictor of mortality than education in a national sample of US adults

Low socioeconomic status (SES) is associated with mortality in several populations. SES measures, such as education and income, may operate through different pathways. However, the independent effect of each measure mutually adjusting for the effect of other SES measures is not clear. The association between poverty-income ratio (PIR) and education and all-cause mortality among 15,646 adults, aged >20 years, who participated in the Third National Health and Nutrition Examination Survey in the USA, was examined. The lower PIR quartiles and less than high school education were positively associated with all-cause mortality in initial models adjusting for the demographic, lifestyle and clinical risk factors. After additional adjustment for education, the lower PIR quartiles were still significantly associated with all-cause mortality. The multivariable odds ratio (OR) [95% confidence interval (CI)] of all-cause mortality comparing the lowest to the highest quartile of PIR was 2.11 (1.52-2.95, p trend < or = 0.0001). In contrast, after additional adjustment for income, education was no longer associated with all-cause mortality [multivariable OR (95% CI) of all-cause mortality comparing less than high school to more than high school education was 1.05 (0.85-1.31, p trend=0.57)]. The results suggest that income may be a stronger predictor of mortality than education, and narrowing the income differentials may reduce the health disparities.     

2012-2016年重庆市居民健康素养趋势性及其影响因素

  目的  了解2012-2016年重庆市居民健康素养水平变化趋势,探讨健康素养水平的影响因素,为卫生相关政策的改进提供科学依据。  方法  2012-2016年采用分层多阶段随机抽样方法对重庆市居民进行问卷调查。  结果  2012-2016年重庆市居民健康素养水平分别是4.94%、8.38%、8.71%、10.16%和11.82%;多因素分析显示,女性（OR=1.018,95% CI:1.015~1.021,P < 0.001）、25~岁（OR=1.037,95% CI:1.033~1.041,P < 0.001）、35~岁（OR=1.143,95% CI:1.139~1.148,P < 0.001）、小学（OR=2.065,95% CI:2.044~2.087,P < 0.001）、初中（OR=3.804,95% CI:3.765~3.843,P < 0.001）、高中/职高/中专（OR=6.245,95% CI:6.179~6.311,P < 0.001）、大专/本科及以上（OR=12.305,95% CI:12.173~12.438,P < 0.001）、家庭人均年收入3 000~元（OR=1.570,95% CI:1.560~1.580,P < 0.001）、5 000~元（OR=1.897,95% CI:1.887~1.907,P < 0.001）、10 000~元（OR=1.885,95% CI:1.875~1.896,P < 0.001）及>15 000元（OR=2.097,95% CI:2.086~2.108,P < 0.001）是健康素养的保护因素;农村、45~岁、55~岁及65~岁是健康素养的危险因素（均有P < 0.001）。  结论  2012-2016年重庆市居民健康素养水平呈逐年上升趋势,应针对农村居民、男性和年龄较大者、文化程度较低者和家庭人均年收入较低者进行健康教育工作。