相對剝奪感對自評健康及負面健康行為之影響

Abstract

研究背景：相對剝奪感為解釋收入不平等和人口健康關係的重要假說。感到相對剝奪者會產生沮喪、羞恥和壓力，增加負面健康行為之風險。本研究目的在於探討相對剝奪感對自評健康及負面健康行為之影響。 研究方法：研究資料來自「民國九十一年臺灣地區國民健康促進知識、態度與行為調查」，包含9,010位男性和8,624位女性之25歲到64歲臺灣人口。相對剝奪採用Yitzhaki index測量，其意義為個人在比較族群內，自己收入與收入較高者收入的期望差距。比較族群定義採用性別、年齡及教育程度三變項之不同組合。負面健康行為包括吸菸、飲酒和嚼檳榔行為。 研究結果：2002年，臺灣25到64歲男性和女性，自評健康差的百分比分別為8.5%和10.0%，吸菸百分比分別為53.4%和4.9%，飲酒百分比分別為17.6%和2.4%，嚼檳榔百分比分別為20.8%和1.4%。對數複迴歸顯示，在控制絕對收入和其他人口學因素之後，男性和女性之勝算比(95％信賴區間)在不同比較族群定義的範圍分別如下：自評健康差─1.19 (0.96-1.47) 到1.76 (1.17-2.66) 及0.94 (0.74-1.18) 到1.47 (0.88-2.45)；吸菸行為─1.07 (0.94-1.21) 到1.40 (1.09-1.80) 及1.08 (0.70-1.67) 到1.61 (1.12-2.32)；飲酒行為─1.12 (0.96-1.31) 到1.30 (1.14-1.49) 及1.07 (0.55-1.97) 到1.71 (1.12-2.62)；嚼檳榔行為─1.20 (1.00-1.43) 到1.44 (1.24-1.66) 及1.39 (0.59-3.26) 到3.00 (1.07-8.43)。整體而言，當比較族群定義為性別、年齡和教育程度時，除女性自評健康外，勝算比皆達統計上顯著水準。 結論：在臺灣，相對剝奪感為自評健康差和負面健康行為的決定因素。

Background: Relative deprivation has been hypothesized as a mechanism in the relation between income inequality and population health. Being relatively deprived causes frustration, shame, and stress, and might increase the probability of engaging in risky behaviors. The aim of this study is to investigate the relationship of relative deprivation with self-rated health and adverse health behaviors in Taiwan. Methods: Data for the analysis came from the 2002 National Survey of Taiwan on Knowledge, Attitude, and Practice of Health Promotion, consisting of 9,010 men and 8,624 women aged 25 to 64. Relative deprivation was measured by using the Yitzhaki index, which calculates the deprivation suffered by each individual as a function of the shortfall between one’s income and the average income of others with higher incomes in that person’s reference group. The definitions of reference groups were constructed by the demographic variables such as gender, age group and educational attainment, as well as combinations of these characteristics. Adverse health behaviors include cigarette smoking, alcohol drinking, and betel nut chewing. Results: In 2002, the percentage of men and women aged 25-64 in Taiwan were 8.5% and 10.0% for reporting poor health, 53.4% and 4.9% for cigarette smoking, 17.6% and 2.4% for frequent alcohol drinking, 20.8% and 1.4% for betel nut chewing. After controlling for absolute income and other demographic factors, logistic regressions showed that the adjusted odds ratios (95% confidence intervals) in men and women by different definitions of reference group ranged from: 1.19 (0.96-1.47) to 1.76 (1.17-2.66) and 0.94 (0.74-1.18) to 1.47 (0.88-2.45) for poor self-rated health, 1.07 (0.94-1.21) to 1.40 (1.09-1.80) and 1.08 (0.70-1.67) to 1.61 (1.12-2.32) for smoking, 1.12 (0.96-1.31) to 1.30 (1.14-1.49) and 1.07 (0.55-1.97) to 1.71 (1.12-2.62) for alcohol drinking, 1.20 (1.00-1.43) to 1.44 (1.24-1.66) and 1.39 (0.59-3.26) to 3.00 (1.07-8.43) for betel nut chewing. In general, when using the combination of gender, age and education as the definition of reference group, the associations were all statistically significant, except self-rated health for women. Conclusion: Relative deprivation is a determinant of poor self-rated health and adverse health behaviors in Taiwan.