老年人社会经济地位对健康的影响机制研究——兼论生活方式、公共服务和社会心理的中介效应

社会经济地位差异会带来老年人健康的不平等,社会经济地位的弱势对老年健康产生不利影响,但生活方式、公共服务和社会心理因素可在一定程度上弱化社会经济地位对老年健康的直接影响。基于2014年中国老年健康影响因素跟踪调查(CLHLS)数据,利用有序Logistic回归模型实证分析了社会经济地位对老年人健康状况的影响,并考察了生活方式、公共服务和社会心理维度变量的中介效应。研究发现:社会经济地位越高,老年人的自评健康、生理健康和精神健康状况越好;体育锻炼、食用水果和居住安排等生活方式变量有利于缓解社会经济地位弱势对老年健康的负面影响;医疗服务可及性在社会经济地位与老年健康的关系中具有显著的中介效应,但社区服务丰富性的中介效应不明显;生活满意度和社会参与度也能缓解社会经济地位弱势对健康造成的不利影响。改善老年人的健康状况不仅需要改变部分老年群体的社会经济地位弱势状态,也应该倡导健康的生活方式、提高公共服务水平和促进老年社会参与度。     

社会经济地位对老年人抑郁的影响分析

目的了解老年人社会经济地位现状与抑郁状况,分析社会经济地位中影响老年人抑郁的因素。方法采用分层随机抽样,抽取莆田市城乡1064名65岁及以上老年人进行问卷调查,测量体现社会经济地位的教育水平、居住区域、住房性质、未来经济预期,通过老年抑郁简式量表GDS-15测量老年人抑郁状态情况,统计方法采用描述性、χ²检验和二元Logistic回归对数据进行分析。结果研究人群抑郁患病率为8.3%(85/1029),城乡老年人抑郁率差异无统计学意义。多因素回归分析显示:居住在租赁房的老年人患抑郁的可能性是居住在商品房老年人的4.906倍(OR=4.906,95%CI:1.540～15.633),对未来个人经济预期不看好的老年人患抑郁的可能性是对未来个人经济预期看好的老年人的6.210倍(OR=6.210,95%CI:2.735～14.100)。结论社会经济地位对老年人抑郁情况有影响,须着重加强对现居住在租赁房的老年人心理健康的关注。     

中国丧偶老年人居住安排的影响因素分析

目的 探讨我国丧偶老年人居住安排的影响因素,为丧偶老年人养老问题的解决提供合理建议.方法 数据来源为2015年中国健康与养老全国追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据,采用x2检验和无序多分类logistic回归模型对丧偶老年人居住安排...     

不同社会经济地位老年人健康期望寿命研究

目的:研究苏州市社会经济地位(SES)对不同性别老年人健康期望寿命(ALE)占期望寿命(LE)比重的影响.方法:采用分层随机整群抽样的方法.抽取苏州市8个社区共4458名老年人进行日常生活活动能力(ADL)测量.选取SES三个最常用指标收入、教育、职业按两分法分组,探讨不同性别老年人ALE/LE的差异.结果:女性LE高于男性,但ALE随龄递减率快于男性,ALE/LE普遍低于男性;SES高的人群其ALE/LE占优势,但不同SES指标对不同性别人口ALE占余寿比重的影响不同;SES水平不同的人群其ALE/LE的差值随年龄发生变化且呈现性别差异.结论:应加强对SES低水平老年人健康状况的关注,尤其是高龄女性健康,在制定相关政策时考虑性别差异.     

居住安排对我国老年人生活满意度的影响效应分析

目的 探讨居住安排对老年人生活满意度的影响,为实施积极老龄化国家战略,提升广大老年人的幸福感提供实证依据。方法 运用2011—2012年、2014年和2018年中国老年健康影响因素跟踪调查(CLHLS)三期面板数据,采用个体固定效应模型进行分析。结果 描述分析发现,当前我国的养老模式以居家养老为主,老年人与子女同住占比较高,但呈下降的趋势;回归分析显示,在控制老年人社会经济状况和健康状况等情况下,与子女同住最有利于提升老年人生活满意度水平,与其他家人同住次之(β=0.206,95%CI:0.054～0.358),入住养老机构的老年人生活满意度最低(β=-1.021,95%CI:-1.703～-0.339);居住安排对生活满意度的影响效应存在城乡、性别的异质性。经济地位的调节效应显示,相较于经济状况较差,自评经济状况较好的老年人,居住在养老机构有利于其生活满意度的提升,而对“与其他家人同住”的老年人,自评经济状况较好则不利于其生活满意度的提升。结论 在居家养老为主导的养老模式下,应鼓励老年人与家人同住,最理想的状态是与子女同住;在社会政策上应鼓励“普惠型”养老机构服务模式,“兜底”老年弱...     

社会经济地位对老年人抑郁的影响分析北大核心

目的了解老年人社会经济地位现状与抑郁状况,分析社会经济地位中影响老年人抑郁的因素。方法采用分层随机抽样,抽取莆田市城乡1064名65岁及以上老年人进行问卷调查,测量体现社会经济地位的教育水平、居住区域、住房性质、未来经济预期,通过老年抑郁简式量表GDS-15测量老年人抑郁状态情况,统计方法采用描述性、χ~2检验和二元Logistic回归对数据进行分析。结果研究人群抑郁患病率为8.3%(85/1029),城乡老年人抑郁率差异无统计学意义。多因素回归分析显示:居住在租赁房的老年人患抑郁的可能性是居住在商品房老年人的4.906倍(OR=4.906,95%CI:1.540~15.633),对未来个人经济预期不看好的老年人患抑郁的可能性是对未来个人经济预期看好的老年人的6.210倍(OR=6.210,95%CI:2.735~14.100)。结论社会经济地位对老年人抑郁情况有影响,须着重加强对现居住在租赁房的老年人心理健康的关注。     

社会经济地位对居民健康公平的影响

社会经济地位指个人或群体在阶级社会中的位置?社会经济地位是职业、教育、收入、财富以及居住地区等指标的综合反映。社会学家常用社会经济地位作为预测人们行为的一种手段与方式。据对社会经济地位与居民健康状况有关的研究发现：收入差距与健康密切相关；社会经济地位与健康之间有一个梯度关系，而且这并不是只发生在贫困层面；医疗保健服务对健康差距产生的作用比较小；社会经济因素通过多种渠道影响居民的健康状况。     

居住环境对青少年健康的影响及社会适应能力的中介作用

目的 分析青少年居住环境、社会适应能力和健康之间的关系,探讨社会适应能力在居住环境和健康之间的中介效应,为促进青少年健康水平提供建议。方法 利用中国教育追踪调查2013—2014学年和2014—2015学年两期数据,该调查使用多阶段概率和规模成比例抽样方法,以调查问卷的形式在全国随机抽取28个县级单位,112所学校和438个班级进行调查,调查对象包括学生、家长、教师和学校领导。采用多元线性回归模型和偏差校正百分位Bootstrap方法,分析居住环境对青少年健康的影响和社会适应能力在两者间的中介效应。结果 住所环境得分为(2.215±0.731)分,社区环境得分为(2.316±1.186)分,地区类型中郊区占比最大(67.90%),居住方式中双亲同住占比最大(75.14%),邻里环境得分为(0.316±0.544)分;住所环境(β=0.067,P<0.05)和社区环境(β=0.031,P<0.05)与青少年健康呈正向相关关系,地区类型、居住方式和邻里环境与青少年健康之间不显著;社会适应能力在住所环境、社区环境与健康之间均有中介效应,分别占总效应10.35%和19.33%。结论...     

社会经济地位与老年人身心健康:兼论社会交往的中介效应

目的:实证分析社会经济地位与我国老年人身心健康的关系.方法:运用多重线性回归、Sobel检验和Bootstrap检验,分析社会经济地位对老年人身心健康的影响及社会交往的中介效应.结果:社会经济地位对老年人身心健康具有显著正向影响,阶层认同、家庭经济状况和受教育年限每增加1分,老年人自评健康分别增加0.096分、0.22...     

准老年人社会经济地位对机构养老意愿选择的影响——家庭功能与社会交往的多重中介效应

目的 本研究旨在探索准老年人的社会经济地位与机构养老意愿选择间的关系。方法 运用家庭社会经济地位问卷、APGAR家庭功能评估量表、社会交往情况调查,于2019年7-8月对山东省准老年人进行调查和评估。结果 社会交往与家庭功能对于准老年人社会经济地位和机构养老意愿选择之间的中介效应显著,且社会交往的中介效应显著高于家庭功能。结论 未来的养老发展应考虑从社会支持的角度出发,促进养老机构发展。     

Time perspective and socioeconomic status: A link to socioeconomic disparities in health?

Time perspective is a measure of the degree to which one's thinking is motivated by considerations of the future, present, or past. Time perspective has been proposed as a potential mediator of socioeconomic disparities in health because it has been associated with health behaviors and is presumed to vary with socioeconomic status. In this cross-sectional community-based survey of respondents recruited from hair salons and barber shops in a suburb of Washington DC, we examined the association between time perspective and both education level and occupation. We asked participants (N = 525) to complete a questionnaire that included three subscales (future, present-fatalistic, and present-hedonistic) of the Zimbardo Time Perspective Inventory. Participants with more formal education and those with professional occupations had higher scores on the future time perspective subscale, and lower scores on the present-fatalistic subscale, than participants with less formal education or a non-professional occupation. Present-fatalistic scores were also higher among participants whose parents had less formal education. Present-hedonistic scores were not associated with either education level or professional occupation. Time perspective scores were not independently associated with the likelihood of obesity, smoking, or exercise. In this community sample, future time perspective was associated with current socioeconomic status, and past-fatalistic time perspective was associated with both current and childhood socioeconomic status.     

医疗保险对健康状况的影响研究综述

本文回顾了国内外学者对医疗保险和健康状况关系的研究。首先综述了关于医疗保险和健康状况关系的三种观点;其次依据研究的数据来源,将国外文献分为三个层次进行综述;最后,总结了近年来国内学者的相关研究。研究发现:(1)大多数基于观察数据的研究只能证明医疗保险与健康之间存在相关关系,要建立二者之间的因果关系,必须找到克服医疗保险内生性的方法。(2)不同研究的结论不同,但这些结论并不必然矛盾,其原因在于研究对象和研究方法存在差异。(3)研究结论并不是普遍适用的,未来的研究需要关注医疗保险对不同人群健康的长期影响。     

移居老年人的社会关系与心理健康问题研究

目的通过和本地老年人的比较,调查大连市移居老年人心理健康的现状。方法采用随机抽样方法对该市2个街道431名60岁以上老年人进行心理健康状况自评,对数据进行SPSS统计分析。结果移居老年人和本地老年人之间的社会健康状况和心理健康水平都存在显著差距。在参与社会活动,人际关系交往以及满意度,安全感,幸福感,生活充实度的指标上差异有统计学意义。结论移居后的老年人较容易产生心理健康问题。应有针对性地对移居老年人开展心理健康支持。     

社会经济特征、社会支持对城市社区老年人死亡态度的影响研究Symbol`@@

目的 分析城市社区老年人死亡态度的现状及其与社会经济特征、社会支持的关系,为社区老年人死亡教育干预工作提供依据。方法 采用两阶段随机抽样抽取成都市990名老年人进行调查,应用结构方程模型探讨社会经济特征、社会支持对社区老年人死亡态度的影响及作用路径。结果 67.58%的老年人对死亡持接受态度;在老年男女性的路径中,老年男性的家庭人均月收入（P=0.007,β=0.119）和原职业(PSymbol|@@0.001,β=0.180)对死亡态度有直接作用,而文化程度（P<0.001,β=0.127）对死亡态度产生间接作用;老年女性的原职业对死亡态度同时有直接效应（P=0.018,β=0.101）和间接效应（P=0.001,β=0.007）,其中家庭人均月收入（P=0.001,β=0.039）和文化程度(PSymbol|@@0.001,β=0.094)对死亡态度仅有间接作用。社会支持对不同性别老年人的死亡态度均有直接影响和中介作用。结论 城市社区大部分老年人的死亡态度较积极;社会经济特征、社会支持与其死亡态度相关且存在性别差异,提示社区死亡教育干预应重点关注社会经济特征、社会支持因素对老年人死亡态度的影响。     

Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India

Empirical studies from developed countries observe that women report worse health and higher healthcare utilization than men, but the health disadvantage diminishes with age; gender differences in self-rated health often vanish or are reversed in older ages. Comparable assessments of health during later life from developing countries are limited because of the lack of large-scale surveys that include older women. Our study attempts to address the shortage of developing country studies by examining gender differences in health and healthcare utilization among older adults in India. Both ordered and binary logit specifications were used to assess significant gender differences in subjective and objective health, and healthcare utilization after controlling for demographics, medical conditions, traditional indicators of socioeconomic status like education and income, and additional wealth indicators. The wealth indicators, measured by property ownership and economic independence, are regarded as financially empowering older adults to exercise greater control over their health and well-being. Data are drawn from a nationally representative decennial socioeconomic and health survey of 120,942 Indian households conducted during 1995-1996. The study sample comprises 34,086 older men and women aged >or= 60 years. Our results indicate that older women report worse self-rated health, higher prevalence of disabilities, marginally lower chronic conditions, and lower healthcare utilization than men. The health disadvantage and lower utilization among women cannot be explained by demographics and the differential distribution of medical conditions. While successive controls for education, income, and property ownership narrows the gender gap in both health and healthcare utilization, significant differentials still persist. Upon controlling for economic independence, gender differentials disappear or are reversed, with older women having equal or better health than otherwise similar men. Financial empowerment might confer older women the health advantage reflected in developed societies by enhancing a woman's ability to undertake primary and secondary prevention during the life course.     

Opening the black box of the relationship between neighborhood socioeconomic status and mental health: Neighborhood social-interactive characteristics as contextual mechanisms

Previous studies have linked low neighborhood socioeconomic status (NSES) to mental health problems. However, few studies have investigated the mechanisms underlying this association and most focused on the association with negative indicators of mental health, such as symptoms of depression or anxiety. This paper investigated whether neighborhood social characteristics (social interaction, trust, safety, organization participation, and attachment) mediate the association between NSES and mental health. We combined Danish register data with survey data from the North Denmark Region Health Survey 2017. Mental health was assessed with the Rand 12-item Short-form Survey (SF-12). The sample consisted of 14,969 individuals nested in 1047 neighborhoods created with an automated redistricting algorithm. We fitted multilevel structural equation mediation models and used a Monte Carlo simulation method to estimate confidence intervals for the indirect effects. NSES was positively associated with mental health. Neighborhood trust significantly mediated this relationship, accounting for 34% of the association after controlling for other mediators. These results indicate that higher levels of mental health in more affluent neighborhoods are partially explained by higher levels of trust. Improving neighborhood trust could mitigate sociogeographic inequalities in mental health.     

医疗保险制度对老年群体死亡风险的影响——基于CLHLS的生存分析

目的:探讨医疗保险制度对老年群体死亡风险的影响,为我国医疗保障制度的改革与完善提供参考依据。方法:基于中国老年健康影响因素跟踪调查(CLHLS)2011—2014年的追踪数据,以添加脆弱因子的Weibull模型与Gompertz模型进行生存分析,并且分年龄组进行异质性分析。结果:相对于无医保的老人,有医保老人的死亡风险随医保制度的不同而发生不同程度的变化,具体而言,新农合、城镇居民基本医疗保险以及城镇职工基本医疗保险分别降低了约20%、25%以及31%的死亡风险。通过分年龄组进一步分析发现,医疗保险对高龄组老人死亡风险有显著影响,而对低龄组老人的死亡风险的影响不显著。结论:医疗保险制度有助于降低老年群体的死亡风险,但影响程度各异,表现为城镇职工医疗保险最高,城镇居民医疗保险次之,新农合最低。基于此,我国医疗保险制度改革的重点方向在于继续扩大医保覆盖面,并弥合不同医保之间的待遇差异,在统筹城乡居民医疗保险的基础上,进一步推进城镇职工医疗保险与居民医疗保险的整合,最终实现城乡医疗保险制度的一体化发展。     

Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review

Socioeconomic inequalities in health are an important topic in social sciences and public health research. However, little is known about socioeconomic disparities and mental health problems in childhood and adolescence. This study systematically reviews publications on the relationships between various commonly used indicators of socioeconomic status (SES) and mental health outcomes for children and adolescents aged four to 18 years. Studies published in English or German between 1990 and 2011 were included if they reported at least one marker of socioeconomic status (an index or indicators, e.g., household income, poverty, parental education, parental occupation status, or family affluence) and identified mental health problems using validated instruments. In total, 55 published studies met the inclusion criteria, and 52 studies indicated an inverse relationship between socioeconomic status and mental health problems in children and adolescents. Socioeconomically disadvantaged children and adolescents were two to three times more likely to develop mental health problems. Low socioeconomic status that persisted over time was strongly related to higher rates of mental health problems. A decrease in socioeconomic status was associated with increasing mental health problems. The strength of the correlation varied with age and with different indicators of socioeconomic status, whereas heterogeneous findings were reported for gender and types of mental health problems. The included studies indicated that the theoretical approaches of social causation and classical selection are not mutually exclusive across generations and specific mental health problems; these processes create a cycle of deprivation and mental health problems. The review draws attention to the diversity of measures used to evaluate socioeconomic status, which might have influenced the comparability of international epidemiological studies. Furthermore, the review highlights the need for individual-level early childhood interventions as well as a reduction in socioeconomic inequalities at a societal level to improve mental health in childhood and adolescence.