睡眠类型与睡眠时间对医学生自评健康的独立与联合效应研究

目的 探讨睡眠类型、睡眠时间对医学生自评健康状况较差的独立及联合效应。方法 本研究为横断面调查。采用按比例分层整群随机抽样的方法在浙江省某医科大学选取1 526名在校医学生作为研究对象。调查内容主要包括基本人口学特征、睡眠类型、睡眠时间、夜宵、久坐时间和体力活动时间等生活方式信息以及自评健康状况。采用logistic回归模型控制可疑混杂变量后评价睡眠类型、睡眠时间与自评健康的关联性。结果 医学生睡眠类型为晚睡晚起型者最多（664人,43.5%）,其次为中间型（442人,29.0%）、早睡早起型（420人,27.5%）。自评健康状况较差的报告人数占42.8%（653人）。不同睡眠类型医学生自评健康状况较差报告率不等：与早睡早起型相比,中间型、晚睡晚起型者自评健康状况较差比例更高,调整OR值（95%CI）分别为1.69（1.23~2.31）、2.43（1.81~3.26）,趋势检验P<0.001。与每晚睡眠时间≥8 h者相比,睡眠时间为7、≤6 h者自评健康状况较差的OR值（95%CI）分别为1.40（1.07~1.84）、2.38（1.69~3.37）,趋势检验P<0.001。睡眠类型与睡眠时间存在联合效应,调整各种混杂因素后,与早睡早起型且每晚睡眠时间≥8 h的医学生相比,晚睡晚起型且睡眠时间≤6 h者自评健康状况较差的OR值最大,OR值（95%CI）为6.53（3.53~12.09）。结论 晚睡晚起型及睡眠不足均与医学生自评健康状况较差的OR值增加有关联,且两者具有联合效应。建议医学生应尽量早睡早起,并保持充足睡眠,促进健康。     

拉萨地区藏族人群生活行为方式与自评健康状况的关联研究

目的 探讨拉萨地区藏族人群自评健康状况与常见生活行为方式暴露的关联,以期为该人群的健康促进工作提供依据。方法 选取国家重点研发计划“西南区域自然人群队列”中拉萨地区藏族人群作为研究对象,以面对面电子问卷调查方式收集自评健康状况,采用全环境关联研究（EWAS）方法,全面探讨生活行为方式因素与自评健康状况的关联。结果 6 212名藏族人群中自评健康状况非常好占9.1%,较好占55.9%,一般占28.0%,较差或很差占6.9%。EWAS框架下的有序Logistic回归分析显示偶尔饮酒（OR=0.79）、经常饮酒（OR=0.66）、膳食评分（OR=0.97）、每周业余平均锻炼时长2~3 h（OR=0.72）、每周业余平均锻炼时长>3 h（OR=0.84）人群更易有好的自评健康状况。而重度环境烟雾暴露（OR=1.52）人群自评健康状况更差。结论 藏族人群的自评健康状况总体较为乐观,多种生活行为因素与自评健康状况相关,为后续健康教育、促进方向提供理论依据。     

江西省18～60岁城乡居民自评健康状况及影响因素分析

目的了解2015年江西省18～60岁城乡居民自评健康状况,并探索影响自评健康的因素。方法采用多阶段整群随机抽样的方法,抽取江西省10个监测点18岁及以上居民开展慢性病流行状况调查。结果江西省18～60岁城乡居民自评健康状况"好/非常好"、"一般"和"差/非常差"者分别占44.66%、46.23%和9.11%。。自评健康状况无序多分类logistic回归分析发现,自评健康状况"一般"与"差/非常差"比较,城市是农村的1.515倍(95%CI:1.177～1.949),无睡眠问题是有睡眠问题的2.069倍(95%CI:1.591～2.692),无慢性病史是有慢性病史的2.988倍(95%CI:2.189～4.078);而自评健康状况"好/非常好"与"差/非常差"比较,男性是女性的1.431倍(95%CI:1.119～1.830),无睡眠问题是有睡眠问题的2.730倍(95%CI:2.057～3.624),无慢性病史是有慢性病史的6.503倍(95%CI:4.759～8.885)。结论地区、性别、睡眠问题、慢性病史是江西省18～60岁人群自评健康状况的影响因素。应重点关注农村地区、女性、有睡眠问题以及患有慢性病的人群,改善这一群体的自评健康现状。     

我国独居老人自评健康状况及其影响因素研究

目的 了解影响我国独居老人自评健康状况的影响因素,为改善我国独居老人健康及生活质量提供参考依据。方法 通过自评问卷调查方法,采用2018年中国老年健康影响因素跟踪调查（CLHLS）数据,了解独居老人健康状况,采用卡方检验以及多因素logistic 回归方法分析独居老人健康状况的影响因素。结果 1236名独居老年人中,自评健康较好的有551人,占比44.6%,较差的685人,占比55.4%;子女经常看望（OR =1.840,95%CI:1.080~3.135)、体育锻炼（OR =1.813,95%CI:1.385~2.372)、饮酒（OR =1.531,95%CI:1.061~2.209）、体检（OR =1.347,95%CI:1.033~1.756）、慢性病(OR =0.682,95%CI:0.532~0.875)、霉味(OR =0.533,95%CI:0.391~0.726)、睡眠6~9小时（OR =0.528,95%CI:0.393~0.710）、睡眠时间>9小时（OR =0.411,95%CI:0.283~0.597）与独居老人自评健康有关。结论 我国独居老人自评健康状况总体较差。应重视独居老人的子女关怀、生活行为方式、居住环境及慢性病状况等,更好地改善独居老人的健康状况。     

青岛市居民健康素养与健康状况的关系研究

  目的  分析青岛市居民健康素养现状及其与慢性病患病、自评健康状况的关系，探讨健康素养对健康状况的影响，为健康教育干预措施和策略的制定提供依据。  方法  采用分层多阶段与人口规模成比例抽样（probability proportionate to size sampling，PPS）方法，2017年于青岛市抽取10个区（市）16 700名15~69岁常住居民进行问卷调查。  结果  青岛市居民总体健康素养水平为15.92%，慢性病患病率为19.31%，自评健康状况好、一般和差的比例分别为81.68%、12.12%和1.71%；有序Logistic分析显示，在调整城乡、性别、年龄、文化程度、收入、职业等因素后，健康素养是人群慢性病患病和自评健康的保护性因素（OR=1.232，P=0.003；OR=1.159，P=0.033），健康素养的三个方面均与人群慢性病患病和自评健康状况有关（均有P<0.05）。  结论  健康素养与居民健康状况呈正相关关系，健康素养水平的提升是提高居民健康状况的重要途径。     

天津市成年女性人群抑郁症发生现状及影响因素

目的 探讨天津地区成年女性人群抑郁症发生情况及影响因素。方法 采用多阶段随机整群抽样方法抽取天津市成年女性进行调查,采用病人健康问卷抑郁量表（PHQ-9）评估抑郁症发生情况,将成年女性人群分为抑郁症组与未发生抑郁症组,采用二元Logistic回归分析抑郁症发生的影响因素。结果 天津地区3 584名成年女性人群中有432例（12.05%）发生抑郁症,有3 152名（87.95%）未发生抑郁症;抑郁症组年龄≥60岁、体力劳动者、丧偶及离婚、睡眠质量一般或差、健康自评一般或差占比高于未发生抑郁症组,差异有统计学意义（P<0.05或P<0.01）;比较抑郁症组与未发生抑郁症组基线资料后,经二元Logistic回归分析结果显示,年龄≥60岁、体力劳动者、丧偶及离婚、睡眠质量一般或差、健康自评一般或差是成年女性人群发生抑郁症的危险因素。结论天津地区成年女性人群抑郁症发生风险高,与年龄、职业、婚姻状况、睡眠质量、健康自评有关。     

蚌埠市居民自评健康状况及其影响因素分析

目的 了解蚌埠市居民自评健康状况及其影响因素,为提高蚌埠市居民健康水平提供理论依据。方法 采用分层随机抽样的方法抽取蚌埠市不低于18岁常住居民,用自行设计的问卷进行调查,采用多分类Logistic回归对影响居民自评健康的因素进行分析。结果 在接受调查的3 294名居民中,1 536人（46.6%）自评健康为好,1 333人（40.5%）自评健康为一般,425人（12.9%）自评健康为差。多因素分析显示,与自评健康有关的因素有性别、学历、月收入、慢病家族史、现患慢病状况、两周患病情况、医疗保健费用占年收入比、饮酒、体育锻炼、心理健康状况（均有P<0.05）。结论 应加强对重点人群（如男性、低学历、低收入人群等）健康状况的关注,通过健康教育、心理干预等措施改善居民自评健康状况。     

健康生态学视角下我国60岁及以上老年人自评健康的影响因素研究

目的 基于健康生态学视角,探讨我国60岁及以上老年人群自评健康的影响因素。方法 采用横断面调查的方法,以CHARLS 2015的387例60岁以上老年人为研究对象。采用logistic回归分析老年人自评健康的影响因素。结果 老年人自评健康比例仅28.2%。童年健康状况不好（OR=2.928, 95%CI: 2.298~3.826）、住宅商用（OR=1.528, 95%CI: 1.024~2.281）、居住地为农村（OR=1.467, 95%CI: 1.164~1.85）、夜间睡眠时间（OR=0.862, 95%CI: 0.828~0.91）、饮酒（OR=0.735, 95%CI: 0.583~0.927）、戒酒（OR=1.862, 95%CI: 1.301~2.665）、人际交往（OR=0.791, 95%CI: 0.651~0.962）、工作类型非农业（OR=0.608, 95%CI: 0.44~0.84）、住房有洗澡设施（OR=0.817, 95%CI: 0.669~0.999）与老年人自评健康有关。结论 需要将老年健康干预时间前移,并从个体到环境因素加强对老年健康的干预。     

我国15岁及以上居民自评健康状况及其影响因素分析

目的:分析我国15岁及以上居民自评健康状况及其影响因素。方法:采用第五次国家卫生服务调查居民调查资料(n=273 688),测量指标包括调查对象的社会人口学特征、健康相关行为、健康相关生命质量、两周患病、慢性病患病和过去一年内住院情况。剔除无效数据之后有效样本量为188 697,采用有序多分类logistic回归分析对15岁及以上居民自评健康的影响因素进行分析。结果:我国15岁及以上居民自评健康存在明显的社会人口学差异,女性、老年人、低收入、城市(相比于农村)和西部(相比于东中部)居民自评健康等级较差;自评健康状态能够较好地反映中国居民的客观健康状况;健康相关行为良好的居民自评健康状况较好。结论:加强对重点人群(如女性、老年人、低收入人群等)健康状况的关注;改善健康相关行为方式,减少可控的危险因素,诸如不吸烟、不过量饮酒、有规律的体育锻炼等是改善居民自评健康状况的重要手段。     

重庆市九龙坡区60岁及以上老年人失能现况及影响因素分析

了解重庆市九龙坡区60岁及以上老年人失能现况及影响因素,为改善老年人健康状况,制定相关卫生政策提供参考及建议。方法 2022年10—12月,采用多阶段分层整群随机抽样方法,在九龙坡区抽取600名60岁及以上老年人进行面对面电子问卷调查。调查内容主要包括基本人口学信息、日常生活能力情况、跌倒状况、个人健康行为方式和健康状况。采用Katz日常生活功能指数量表衡量调查对象失能状况,使用SPSS 25.0软件对数据进行统计分析,通过多因素Logistic回归分析失能的影响因素。结果 600名调查对象平均年龄为（70.47±6.41）岁,16.67%的调查对象在过去1年内发生过跌倒,89.00%的调查对象经常进行体育锻炼,6.00%的调查对象自评健康状况为差。自述患脑血管病、心脏病、骨关节病、骨质疏松症、帕金森病和阿尔兹海默症的调查对象人数比例分别为4.50%、12.00%、7.83%、13.33%、0.33%、0.33%。调查对象失能发生率为7.17%（43/600）。6项日常生活能力有问题的老年人占比最高是控制大小便（2.50%）,最低是穿衣和洗澡（1.33%）。多因素Logistics回归分析结果显示,80~岁年龄段的调查对象（OR=3.96,95% CI：1.85~8.50）、自评健康状况差（OR=19.49,95% CI：4.51~84.15）和自评健康状况一般（OR=7.56,95% CI：2.20~26.00）的调查对象、过去1年内发生过跌倒的调查对象（OR=2.97,95% CI：1.52~5.80）、自报患有脑血管病（OR=3.79,95% CI：1.18~12.17）和骨质疏松症（OR=4.17,95% CI：1.77~9.80）的调查对象更容易发生失能（P＜0.05）。结论 重庆市九龙坡区60岁及以上老年人日常生活活动能力失能率较高,应对80~岁年龄段、自评健康状况差、发生过跌倒、患有脑血管病和骨质疏松症的老年人积极开展针对性的早期预防和干预。     

Self-rated health and mortality in people with diabetes.

OBJECTIVES. This study examined whether self-rated health is an independent and significant predictor of mortality in people with diabetes, using data collected in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. METHODS. Participants were asked to rate their health in comparison with others their age. A proportional hazards model was used to regress survival time on self-rated health and a number of covariates measuring physical health. RESULTS. People with younger onset diabetes (n = 891) who rated their health relative to their peers as "worse" or "don't know" were no more likely to die than those rating their health as "the same" or "better" when physical health status was controlled. In contrast, those with older onset diabetes (n = 987) who rated their health as "worse" or "don't know" were almost twice as likely to die as those rating their health as "the same" or "better" when physical health status was controlled. CONCLUSIONS. Self-rated health is a significant predictor of mortality in people with older onset diabetes but not in those with younger onset diabetes when physical health status is controlled.     

Association of smoking with other lifestyle factors and mental health status of Japanese factory workers

A self-administered questionnaire survey was conducted among factory workers in Japan. The questionnaire included items concerning eight health practices recommended by Morimoto and the General Health Questionnaire-28. Data from 1598 male workers were analyzed. There were few differences in comprehensive health status due to smoking status, but smokers under the age of 30 years had worse lifestyle habits than nonsmokers with regard to favorable drinking and eating breakfast, and smokers between the ages 30 and 44 years had worse lifestyle habits with regard to favorable drinking and eating breakfast, and better habits regarding sleeping hours and working hours. Smokers under 30 showed worse mental health status than ex-smokers with regard to social dysfunction, though there was little difference between those aged from 30 to 44 and those 45 and older. The results suggested the importance of considering the difference in lifestyle and mental health status due to smoking status when providing advice for improving health habits.     

Implications of black immigrant health for U.S. racial disparities in health

This paper contributes to a growing understanding of U.S. black-white health disparities by using national-level data to disaggregate the health status of black Americans into the following subgroups: U.S.-born blacks, black immigrants from Africa, black immigrants from the West Indies, and black immigrants from Europe. Using new data on the 2000 and 2001 National Health Interview Surveys (NHIS), the authors compare the status of U.S.- and foreign-born blacks to that of U.S.-born whites on three measures of health. The analysis finds that U.S.-born and European-born blacks have worse self-rated health, higher odds of activity limitation, and higher odds of limitation due to hypertension compared to U.S.-born whites. In contrast, African-born blacks have better health than U.S.-born whites on all three measures, while West Indian-born blacks have poorer self-rated health and higher odds of limitation due to hypertension but lower odds of activity limitation. These findings suggest that grouping together foreign-born blacks misses important variations within this population. Rather than being uniform, the black immigrant health advantage varies by region of birth and by health status measure. The authors conclude by exploring the implications of these findings for researchers, health professionals, and public policy.     

Health status among young people in Slovakia: comparisons on the basis of age, gender and education

This study examines the health status of young people in Slovakia. Six subjective health indicators (self-rated health, long-standing illness, vitality, mental health, long-term well-being over the last year and occurrence of health complaints during the previous month) were used to assess the health status of three age groups: first grade secondary school students (mean age 15.9 years), third grade students (mean age 17.8 years) and secondary school leavers (mean age 19.6 years). Females rated their health worse than males on all six indicators (most of these differences were statistically significant). For males, younger age was associated with better self-rated health, less long-standing illness and higher levels of long-term well-being during the previous year. For females, the age differences were more complicated: third grade females reported significantly worse health status in terms of vitality, long-standing illness and number of health complaints than the other two age groups. An analysis of health status by educational level (attendance at or completion of grammar, technical or apprentice school), revealed that grammar school third grade females reported worse health than all other respondents on all six indicators. The third grade of grammar school in Slovakia puts particular stresses on students and, since it has been suggested that females may react more negatively than males to stressful events, this may contribute to their more negative self reports.     

2128名北京市职业人员自测健康现状及影响因素分析

目的了解北京市职业人群自测健康现状及其影响因素。方法采取分层随机抽样的方法抽取2128名18~60岁的5类职业人群为研究对象,采用访谈和问卷相结合的方式进行问卷调查。结果不同文化程度、职业、经济收入、婚姻状况、工作紧张程度、锻炼程度的职业人群自测健康得分差异具有统计学意义（P〈0.05）;教师、企事业单位员工、科技人员的自测健康得分分别为320.50±50.45分,322.02±50.64分和325.50±45.60分,低于体力劳动者的349.69±47.33分和公务员的340.07±51.89分（P〈0.01）;参加锻炼者的得分为344.70±49.48分,高于不锻炼者322.90±49.35分（P〈0.01）;自测健康得分呈现随工作紧张度增加而降低的趋势（P〈0.01）。多因素方差分析结果显示高中或中专文化程度、在婚、体力劳动者、工作紧张度低的人群自测健康得分较高。结论以教师、企事业单位员工、科技人员为重点人群,以增加体育锻炼和促进心理健康为主要内容,开展广泛的工作场所健康教育与健康促进工作。     

The influence of age at migration and length of residence on self-rated health among Swedish immigrants: a cross-sectional study

Objective. Increasing global migration has led to profound demographic changes in most industrialised countries. A growing body of research has investigated various health aspects among immigrant groups and found that some immigrant groups have poorer health than the majority population. It has been suggested that poor acculturation in the host country could lie behind the increased risk of worsened health among certain immigrant groups. The aim was to investigate the cross-sectional association between acculturation, measured as age at migration or length of residence, and self-rated health among young immigrants.

Design. The simple, random samples of 7137 women and 7415 men aged 16–34 years were based on pooled, independent data collected during the period 1992–1999 obtained from the Swedish Annual Level of Living Survey (SALLS). Logistic regression was applied in the estimation of odds ratios (OR) for poor self-rated health, after accounting for age, sex, socioeconomic status (SES) and social networks. The non-response rate varied between 23.6 and 28.3% in the different immigrant groups.

Results. The odds of poor self-rated health increased with increasing age at migration to Sweden among first-generation immigrants. For those who had resided in Sweden less than 15 years the odds of poor self-rated health were significantly increased. In addition, most of the immigrant groups had higher odds of poor self-rated health than the reference group.

Conclusions. Health care workers and policy makers need to be aware that immigrants who arrive in the host country at higher ages and/or have lived in the host country for a shorter period of time might need special attention as they are more likely to suffer from poor self-rated health, a valid health status indicator that can be used in population health monitoring.     

John Henryism, self-reported physical health indicators, and the mediating role of perceived stress among high socio-economic status Asian immigrants

This study examined the relationship between John Henryism (a strong behavioral predisposition to engage in high effort coping with difficult barriers to success) and self-reported physical health among high socio-economic (SES) status Asian immigrants to the USA. Cross-sectional data were collected from a community sample of 318 self-identified Chinese and Indian immigrants aged 18-73, averaging 10.2 yr lived in the US. In addition to the John Henryism Active Coping Scale, health status was measured using ordinal ratings of global self-rated health, somatic symptoms and physical health functioning. We also evaluated whether perceived stress would explain the relationship between John Henryism and health. Controlling for demographic factors, regression analyses showed that higher John Henryism significantly predicted better self-rated health and physical functioning, and fewer somatic symptoms. These relationships were significantly and fully mediated (for physical functioning and somatic symptoms) or partially mediated (for self-rated health) by lower perceived stress. Results suggest that John Henryism relates to better health among high SES Asian immigrants in part by reducing perceived stress. To better understand and improve health in all racial/ethnic groups, especially racial minorities and immigrants, more research is needed on John Henryism and perceived stress as important psychosocial mechanisms intervening between environmental exposures and health outcomes.     

Arab immigrants: a new case for ethnicity and health?

Community-based studies of Arab Americans point to significant health problems among the immigrants, a finding that runs contrary to theories of immigrant selectivity. This study is the first to use nationally representative data to test this question. Using new questions that identify region of birth in the 2000 and 2001 National Health Interview Surveys, we compare the self-rated health and activity limitation of Arab immigrants to US-born white Americans and test the extent to which social, demographic, and immigrant characteristics account for observed disparities. The results find that Arab immigrants do not significantly differ from US-born whites in their self-rated health and are less likely to report limitations in activity. Length of time in the US has no composite effect on health; however, US citizenship does. Compared to the most recent immigrant arrivals, Arab immigrants who are citizens report worse health while their peers who are not officially American (non-citizens) do not, regardless of their duration of US residency. Contrary to prior studies on Arab health, we find that Arab immigrants are not uniformly disadvantaged in their health outcomes and that their health profile is more diverse than currently documented. The results also suggest that controlling for years of US residency may be insufficient for capturing the cumulative effects of acculturation on immigrant health. We conclude by suggesting avenues of future research for capturing heterogeneity among emergent ethnic populations such as Arab Americans.     

Does an immigrant health paradox exist among Asian Americans? Associations of nativity and occupational class with self-rated health and mental disorders

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called “epidemiological paradox” or “immigrant health paradox”. To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002–2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes – perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like “immigrant health paradox” which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.