臺灣老年人社經地位與健康之關係—長期追蹤研究

Abstract

背景：許多研究已經發現高社經地位者，其健康狀況較佳，但攸關老年人健康不平等的研究不多，且健康不平等現象是否會與年齡俱增的結論並不一致。 目的：本研究旨在採用長期追蹤資料，考慮存活選擇的影響，探討臺灣老年人健康不平等是否隨著年齡增加而擴大。 方法：資料來源為行政院衛生署國民健康局之「臺灣地區中老年身心社會生活狀況長期追蹤調查」，於1989與2003年間追蹤4049名60歲以上老年人。以基期之教育程度、每月金錢收入，以及居住房屋所有權為社經地位指標。健康結果變項包含存活狀況、自評健康狀況、日常生活活動功能，與工具性日常生活活動功能。採用廣義化估計方程式來進行長期追蹤的分析。 結果：就13年累積死亡率而言，社經地位愈高，累積死亡率愈低，未就學為59.8%、國小為50.2%、國中以上則為43.2%；每月收入4999元以下為65.9%、5000-14999元為50.1%、15000元以上則為42.4%；居住房屋非自己自所有為59.2%、自己所有為48.8%。 就自評不健康方面，未就學與國中以上相對比例自2.71減少為2.01，若將已死亡者納入計算，則更減少為1.25，而採用每月金錢收入與居住房屋所有權時，也發現一致的結果。除此之外，就日常生活活動功能與工具性日常生活活動功能而言，亦呈現相同的趨勢。 在控制其他變項之後，老年人健康不平等並不隨著年齡增加而擴大。採用不同社經地位指標與健康結果進行分析時，可發現一致性的結果。除此之外，將已死亡者納入分析之後，無論男女，健康不平等仍舊並不隨年齡增加而擴大。 結論：無論納入死亡者與否，老年人健康不平等並不隨著年齡增加而擴大。

Background: Many studies have found that the higher socioeconomic status, the better health, however, only few studies have focused on the elderly group. Moreover, the result of whether or not the health inequalities increased with the rising age was still inconsistent. Objective: By using a longitudinal data and concerning the mortality selection to investigate whether the health inequalities among the elderly have increased with the rising age in Taiwan. Methods: Data were obtained from the five waves of the” Survey of Health and Living Status of the Elderly in Taiwan” from 1989-2003, and 4049 over 60 years old people were followed up. The socioeconomic status indicators comprised educational attainment, monthly income, and housing tenure measured at the baseline. Mortality, self-rated health status, activities of daily living (ADLs), and the instrumental activities of daily living (IADLs) were the health outcomes. The general estimate equations (GEE) were used for longitudinal analysis. Result: According to the 13-year cumulative mortality, the higher socioeconomic status, the lower mortality (no school 59.8%, primary 50.2%, secondary 43.2%; lower than 4999 dollars 65.9%, 5000 to 14999 dollars 50.1%, more than 15000 dollars 42.4%; house owner 59.2%; non house owner 48.8%). For self-rated poor health, the relative difference between no school and secondary has declined from 2.71 to 2.01, and to 1.25 after including the people died at the follow up, and the same patterns could also be found by monthly income and housing tenure. In addition, both the ADLs and IADLs have shown the same trends. After controlling the other variables, both male and female health inequalities among the elderly did not increase with the rising age. The same patterns could also be found by analyzing different socioeconomic status indicators and health outcomes. Moreover, even if the study included the people died at each survey to banish the effect from the results, the health inequalities among the elderly still have not increased with the rising age. Conclusion: Even though we have adjusted the mortality selection effect, the health inequalities among the elderly did not increase with the rising age.