健康移民效应的实证研究——青年流动人口健康状况的变化趋势及影响因素

目的:通过分析青年流动人口健康状况随时间的变化趋势,对健康移民效应进行实证研究,为制定流动人口健康保障相关政策提供依据。方法:本文利用"2015年青年流动人口健康意识调查"数据,对3 001名青年流动人口及1 531名当地人口进行分析,用体质指数(BMI)作为衡量健康的客观指标。结果:流动时间小于1年的青年流动人口,其超重/肥胖的比例为12.5%,要低于当地人口的18.9%(P0.05)。随着流动时间的延长,青年流动人口超重及肥胖的比例逐渐接近当地人口;当流动时间达到5年及以上时,超重/肥胖的比例达到27.8%,高于当地人口。多因素分析结果表明,在婚、经济收入5 000元/月及以上、参加保险、吸烟、经常喝酒、流动时间较长的青年流动人口超重/肥胖的比例较高,与健康状况变差有关。结论:加大健康促进力度,倡导健康生活方式,相关部门应采取必要的措施以改善流动人口卫生服务利用,降低流动人口异地就医障碍,保障流动人口健康。     

三峡移民与当地居民生活满意度、健康状况与医疗服务利用比较

目的：了解移民与当地居民在健康状况和医疗服务利用方面是否有明显差别,提出改善移民健康水平的建议及措施。方法：使用定性深入访谈和定量问卷相结合的方法,对三峡移民的健康状况和医疗服务利用情况进行调查,以当地居民作为对照。结果：除少数地区外,三峡移民身体健康状况、医疗服务利用以及医疗费用、新型合作医疗报销比例与当地居民差距不大。但移民对家庭经济改善、住房改善及人际关系的满意度较低,显示存在心理健康问题。建议：深入宣传新农合章程,说服未参加新农合的移民参合,组织当地居民、医生与移民交流,及时解决移民房屋的质量问题,持续对缺乏劳动技术的移民进行培训,吸收满足条件的移民进入村委会、教师队伍等。     

Race, socioeconomic status, and health: a study of age differences in a depressed area

According to the findings of a health survey conducted among 906 young, middle-aged, and elderly residents of an economically depressed area of Alameda County, California, health status is more strongly associated with income than with race, particularly among middle-aged residents. Although income is also significantly associated with health among both young and elderly residents, it is of little substantive importance. These findings support previous research showing that a measure of income difference (less than $6,500 a year), even among residents of a depressed area, can be sufficiently sensitive to identify a group in poor health. More important, the relationship between low income and poor health is most pronounced among middle-aged residents, indicating that the public health needs of these people deserve special attention.     

Where wealth matters more for health: The wealth–health gradient in 16 countries

Researchers have long demonstrated that persons of high economic status are likely to be healthier than persons of low socioeconomic standing. Cross-national studies have also demonstrated that health of the population tends to increase with country's level of economic development and to decline with level of economic inequality. The present research utilizes data for 16 national samples (of populations fifty years of age and over) to examine whether the relationship between wealth and health at the individual-level is systematically associated with country's level of economic development and country's level of income inequality. The analysis reveals that in all countries rich persons tend to be healthier than poor persons. Furthermore, in all countries the positive association between wealth and health holds even after controlling for socio-demographic attributes and household income. Hierarchical regression analysis leads to two major conclusions: first, country's economic resources increase average health of the population but do not weaken the tie between wealth and health; second, a more equal distribution of economic resources (greater egalitarianism) does not raise health levels of the population but weakens the tie between wealth and health. The latter findings can be mostly attributed to the uniqueness of the US case. The findings and their significance are discussed in light of previous research and theory.     

湖南省东江水库农村移民心理健康状况及影响因素分析

目的 探讨东江水库农村移民心理健康状况、社会支持状况及影响因素,为移民决策提供依据。 方法 在资兴市有东江水库移民的乡(镇)采用分层整群抽样的方法抽取后靠移民和原居民各150人,外迁移民和原居民各150人,用社会支持评定表(SSRS)、症状自评量表(SCL-90)和自编的基本情况调查问卷进行调查,调查移民心理健康现状及影响因素。 结果 ⑴东江水库移民SCL-90阳性检出率为23.5%。⑵后靠移民家庭年均纯收入低于当地原居民(χ²=16.659,P=0.000),外迁移民家庭收入与当地原居民比较差异无统计学意义;当地原居民文化程度总体高于移民(χ²=29.30,P=0.000)。⑶后靠移民SCL-90因子强迫症状、抑郁、焦虑、精神病性症状等因子阳性检出率均显著高于当地原居民(t=1.831、1.919、2.789、1.932,P=0.034、0.028、0.03、0.027),但外迁移民与当地原居民SCL-90总均分及各因子得分阳性检出率比较差异无统计学意义。⑷后靠移民和外迁移民的SCL-90阳性检出率无性别差异,文化程度越低阳性检出率越高(χ²=8.583,P=0.014),后靠移民以31~59岁阳性检出率最高(χ²=7.124,P=0.028),但外迁移民以60岁以上人群最高(χ²=15.396,P=0.000)。⑸外迁移民和后靠移民与原住居民的客观支持、主观支持、对支持的利用度及支持总分比较差异无统计学意义。 结论 移民生活30年后,东江水库后靠移民心理健康状况较原住居民差,应采取相应措施,改善后靠移民的心理健康状况;从长远来看,外迁移民的方式对移民的心理健康更有利。     

Selective migration, health and deprivation: a longitudinal analysis

Population migration is a major determinant of an area's age-sex structure and socio-economic characteristics. The suggestion that migration can contribute to an increase or decrease in place-specific rates of illness is not new. However, differences in health status between small geographical locations that may be affected by the inter-relationships between health, area-based deprivation and migration are under-researched. Using the Office for National Statistics (ONS) England and Wales Longitudinal Study (LS) 1971-1991, this research tracks individuals to identify any systematic sorting of people that has contributed to the area-level relationships between health (limiting long-term illness and mortality) and deprivation (Carstairs quintiles). The results demonstrate that among the young, migrants are generally healthier than non-migrants. Migrants who move from more to less deprived locations are healthier than migrants who move from less to more deprived locations. Within less deprived areas migrants are healthier than non-migrants but within deprived areas migrants are less healthy than non-migrants. Over the 20 year period, the largest absolute flow is by relatively healthy migrants moving away from more deprived areas towards less deprived areas. The effect is to raise ill-health and mortality rates in the origins and lower them in the destinations. This is reinforced by a significant group of people in poor health who move from less to more deprived locations. In contrast, a small group of unhealthy people moved away from more deprived into less deprived areas. These countercurrents of less healthy people have a slight ameliorating effect on the health-deprivation relationship. Whilst health-deprivation relationships are more marked for migrants there are also health (dis-) benefits for non-migrants if their location becomes relatively more or less deprived over time. Overall we found that between 1971 and 1991, inequalities in health increased between the least and most deprived areas, compared with the health-deprivation relationship which would have existed if peoples' locations and deprivation patterns had stayed geographically constant. Migration, rather than changes in the deprivation of the area that non-migrants live in, accounts for the large majority of change.     

Health and rapid economic change in the late twentieth century

Rapidly expanding economies, such as the post-war Tiger Economies, are associated with increasing health and rapidly contracting economies, such as Central and Eastern Europe in the early 1990s, are associated with declining health. In Central and Eastern Europe health decline in association with economic contraction has been mediated by changes in income distribution and, also, by health-determining aspects of civil society. The nations of Central and Eastern Europe are an example of swift economic and political transformation occurring concurrently with economic decline; with increasing disparity in income distributions; and with high levels of distrust in civil institutions. Concurrent with these declines was a marked reduction in health status, described here in terms of life expectancy. Conversely, the nations of Southeast Asia experienced rapid economic growth and increasing life expectancies. Though data are scarce, the experience of the Tiger Economies appears to be one of economic growth; a virtuous cycle of increased investment in education and housing; and increasing parity in income distribution based upon a relatively equitable distribution of returns on education.     

山东省三峡移民健康状况及影响因素分析

目的 探讨山东省三峡移民的健康状况并分析其影响因素.方法 采用分层整群抽样方法抽取山东省4市三峡移民617人为研究对象,选取当地居民663人为对照;采用自制问卷进行面对面访谈,调查移民健康状况并进行影响因素分析.结果 三峡移民2周患病209人,2周患病率为33.9%,慢性病患病216人,患病率为35.0%,二者均高于当地居民(176人,26.5%和189人,28.5%),差异均有统计学意义(P<0.05);年龄、职业、生活适应程度、个人收入满意度是2周患病的影响因素(P<0.01);年龄、生活适应程度、个人收入满意度是慢性病的影响因素(P<0.05).结论 三峡移民的健康状况较差,应根据移民的需求情况提供合适的卫生服务,保障移民身体健康.     

Equity in health and health care: the Chinese experience.

This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.     

我国农村不同收入居民健康状况与生命质量研究

目的：评价不同收入农村居民的健康状况及健康相关生命质量,分析家庭经济对人群健康的影响及其健康问题的特点。方法：采用欧洲五维度健康量表对不同收入农村居民的健康状况进行测量。结果：五维度任一维度存在问题的比例随着收入的降低而增高,而VAS评分也随之降低。低收入阶层在两周患病率、慢性病患病率、年需住院率三个指标上呈现出＂三高＂的现象,应住院未住院率则随着收入的降低而增高。结果提示,低收入阶层存在的健康问题多,对卫生服务的需要高但利用低,女性人群有健康问题比例较男性高。结论与建议：经济收入对居民有较大的影响,要关注低收入老年人群和女性群体,政府应该完善健康保障制度,强化医疗救助政策,降低低收入人群卫生服务的经济障碍,提高健康和卫生服务利用的公平性。     

Exceptions to the rule: healthy deprived areas and unhealthy wealthy areas

In general, inhabitants of low socio-economic areas are unhealthier than inhabitants of high socio-economic areas, but some areas are an exception to this rule. These exceptions imply that other factors besides the socio-economic level of an area contribute to the health of the inhabitants of an area, e.g. environmental factors. In our study we concentrate on areas within the Netherlands that are healthier or unhealthier than could be expected based on their socio-economic level. This study first identifies these areas and secondly determines which area characteristics distinguish these areas from those areas where the level of health is in agreement with their socio-economic level. We used nation-wide data on neighbourhood differences in population composition (gender, age, marital status and ethnicity), urbanisation and two health indicators: mortality and hospitalisation rates. In the Netherlands, many areas are healthier or unhealthier than could be expected based on their income level alone. Areas with higher mortality rates than expected are mainly urban areas with high percentages of elderly people and persons living alone. Similar but opposite associations are observed for areas with lower mortality rates than expected, which are further characterised by a low percentage of non-western immigrants. Areas with lower hospitalisation rates than expected are mainly rural areas with few non-western immigrants. From these results, we conclude that urbanisation and residential segregation based on age, ethnicity and marital status might be important contributors to geographical health inequalities.     

Physician use in Ontario and the United States: The impact of socioeconomic status and health status.

OBJECTIVES: This study compared physician use in Ontario and the midwestern and northeastern United States for persons of different socioeconomic status and health status. The distribution of health problems associated with the most recent physician visit also was compared. METHODS: The design of the study was cross sectional; data derived from the 1990 Ontario Health Survey and the 1990 US National Health Interview Survey were used in analyses. RESULTS: Overall, persons in Ontario averaged 19% more visits than US residents, but differences varied markedly across income and health status. At each level of health status, low- income Canadians had 25% to 33% more visits than their US counterparts. However, among higher income persons, those in excellent or very good health had 22% more visits than Americans, while those in good, fair, or poor health had 10% fewer visits than Americans. Higher visit rates in Ontario were not associated with a greater prevalence of low- priority visits. CONCLUSIONS: Under the Canadian single- payer system, medical care in Ontario has been redistributed to low-income persons and the elderly. Compared with the United States, there has been a lower intensity of medical care for the sick higher income population.     

Poverty area residence and changes in depression and perceived health status: evidence from the Alameda County Study

BACKGROUND: Previous evidence from the Alameda County Study indicated that residential area has an independent effect on risk for mortality, adjusting for a variety of important individual characteristics. The current research examined the effect of poverty area residence on risk for developing depressive symptoms and decline in perceived health status in a sample of 1737. METHODS: Data were from a longitudinal population-based cohort. Multiple logistic regression analyses were used. RESULTS: Age- and sex-adjusted risk for incident high levels of depressive symptoms in 1974 was higher for poverty area residents (odds ratio [OR] 2.14; confidence interval [CI]: 1.49-3.06). Those reporting excellent/good health in 1965 were at higher risk for having fair/poor health in 1974 if they lived in a poverty area (age- and sex-adjusted OR 3.30; CI: 2.32-4.71). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with change in outcome variables. CONCLUSION: These results further support the hypothesis that characteristics of place affect health conditions and health status.     

居民身心健康状况对职业收入的影响——基于倾向得分匹配法(PSM)的实证研究

目的：探究居民心理健康及身体健康对职业收入的影响,为制定健康相关政策提供参考。方法：基于中国社会综合调查2015年数据（CGSS2015）,对3 251名居民进行分析,利用倾向得分匹配法（PSM）探究居民的健康职业收入效应。结果：居民健康状况显著影响职业收入,且存在性别差异。OLS回归结果显示心理健康良好能使年职业收入上升12.3%（P<0.001）;身体健康状况较好,其年职业工资收入上升7.1%（P<0.05）。PSM分析结果显示对应于不同的匹配方式,心理健康状况较好者,其年职业收入平均上升11.8%~12.1%;身体健康状况对职业收入的影响不存在统计学意义。性别方面,OLS回归结果显示女性心理健康状况良好能使其年职业收入上升13.5%（P<0.01）,高于男性的11.8%（P<0.05）;PSM回归结果显示女性心理健康状况良好能使其职业年收入上升13.5%~14.1%,而男性为12.1%。结论：居民心理健康状况显著影响其职业收入,女性的职业收入更易受心理健康状况的影响。应关注居民心理健康,推动建立健全我国心理咨询服务及相关人才培养制度,完善职业场所工作人员心理健康管理,提升健康人力资本,促进国民经济发展。     

Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US)

STUDY OBJECTIVES:: To determine which area based socioeconomic measures can meaningfully be used, at which level of geography, to monitor socioeconomic inequalities in childhood health in the US. DESIGN: Cross sectional analysis of birth certificate and childhood lead poisoning registry data, geocoded and linked to diverse area based socioeconomic measures that were generated at three geographical levels: census tract, block group, and ZIP code. SETTING: Two US states: Massachusetts (1990 population=6,016,425) and Rhode Island (1990 population=1,003,464). PARTICIPANTS: All births born to mothers ages 15 to 55 years old who were residents of either Massachusetts (1989-1991; n=267,311) or Rhode Island (1987-1993; n=96 138), and all children ages 1 to 5 years residing in Rhode Island who were screened for lead levels between 1994 and 1996 (n=62,514 children, restricted to first test during the study period). MAIN RESULTS: Analyses of both the birth weight and lead data indicated that: (a) block group and tract socioeconomic measures performed similarly within and across both states, while ZIP code level measures tended to detect smaller effects; (b) measures pertaining to economic poverty detected stronger gradients than measures of education, occupation, and wealth; (c) results were similar for categories generated by quintiles and by a priori categorical cut off points; and (d) the area based socioeconomic measures yielded estimates of effect equal to or augmenting those detected, respectively, by individual level educational data for birth outcomes and by the area based housing measure recommended by the US government for monitoring childhood lead poisoning. CONCLUSIONS: Census tract or block group area based socioeconomic measures of economic deprivation could be meaningfully used in conjunction with US public health surveillance systems to enable or enhance monitoring of social inequalities in health in the United States.     

Health conditions and residential concentration of poverty: a study in Rio de Janeiro, Brazil

STUDY OBJECTIVES: To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil. DESIGN: All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 "administrative regions" that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: "infant mortality rate"; "standardised mortality rate"; "life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation. MAIN RESULTS: The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums. CONCLUSIONS: The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.     

Economic impact of public sector spending on health care

Public sector spending on health care clearly has a positive economic impact on local communities. Not only does such spending provide residents with better health care, but it is widely recognized as an investment that returns continual dividends in the form of better jobs, higher incomes, and additional state and local tax revenues. The results of a static input/output model shows that public sector spending on health care of approximately $46 billion (in 2009 dollars) in the state of Texas yields over 588,000 jobs, $74.2 billion in total output, $26.3 billion in personal income, $22 billion in employee compensation, and $1.8 billion in state and local taxes; it clearly has a considerable positive economic impact on local economies and their quest for economic development.     

A comparison of health-risk behaviors of rural migrants with rural residents and urban residents in China

OBJECTIVE: To determine whether rural-to-urban migrants in China are more likely than rural and urban residents to engage in risk behaviors. METHODS: Comparative analysis of survey data between migrants and rural and urban residents using age standardized rate and multiple logistic regression. RESULTS: The prevalence and frequency of tobacco smoking, alcohol intoxication, and commercial sex involvement among migrants were generally lower than or equal to those among the 2 comparison groups. Gender, education, and income were associated with risk behaviors in most cases. CONCLUSION: Socioeconomic status appears to be more important than migration or residential locations in affecting risk behavior.     

Increasing geographical inequalities in health in New Zealand, 1980-2001

BACKGROUND: Recent studies have noted widening health inequalities between rich and poor areas in a number of OECD countries. This paper examines whether health in New Zealand has become more geographically polarized during the period 1980-2001, a time of rapid social and economic changes in New Zealand society. METHODS: Mortality records for each year between 1980 and 2001 were extracted for consistent geographical areas: the 21 District Health Boards operating in New Zealand in 2001 and used to calculate male and female life expectancies for each area. The geographical inequalities in life expectancy were measured by calculating the slope index of inequality for each year between 1980 and 2001. RESULTS: Although overall life expectancy has increased during the period of study, New Zealand has experienced increased spatial polarization in health, with a particularly sharp rise in inequality during the late 1980s and early 1990s. Since the mid-1990s regional inequality has remained at stable but high levels. The polarization in mortality was mirrored by a growth in income inequality during the 1980s and 1990s. CONCLUSIONS: Health inequalities as expressed geographically in New Zealand have reached historically high levels and show little sign of abating. In order to tackle health inequalities, a greater commitment by the New Zealand government to a more redistributive social and economic agenda is required. Furthermore, issues of differentiated and health selective migration, emigration, and immigration need to be addressed as if these are important they should matter more for New Zealand than for almost any other developed nation-state.     

环境砷污染区人群健康危害经济损失分析

目的 探索对环境污染所致的健康危害经济损失分析的实用方法,评价当地环境砷污染的人群健康危害经济损失。方法 以人群健康调查资料为基础,通过补充收集1995年当地的人口数、国民经济净产值、年度个人收入、人群年度急性病发病率、因病缺勤和陪护情况、慢性病患病率、1985-1995年当地人群年龄别死亡率和人口数,结合简易寿命表,选择了3个可量化的指标,估算了环境砷污染区人群健康危害经济损失。结果 以1995年当地GDP和人均收入计算,砷污染区人群归因砷污染的经济损失为:(1)污染区劳动人群减寿对当地GDP损失为50.52元/(人·a),个人收入损失43.71元/(人·a);(2)与对照人群相比,污染区人群平均每年多支出医疗费56.30元/(人·a);(3)砷污染区劳动年龄人群健康生活日损失对GDP的损失为74.14元/(人·a),对劳动者个人收入损失为64.23元/(人·a)。三项经济损失之和:国家经济损失为180.96元/(人·a);个人经济损失(包括多支医疗费用)164.27元/(人·a)。结论该方法基本可用于估算环境污染健康危害的经济损失。