目標:本研究使用「台灣地區中老年身心社會生活狀況長期追蹤調查」資料,應用集中指數(concentration index, CI)及相對不平等指數(relative index of inequality, RII)檢視中高齡人口與所得相關之死亡率不平等情形。方法:使用1999及2003年兩波資料及其2000-2003及2004-2007死亡與否為死亡情形之測量。所得測量乃受訪者及其配偶各項年所得總和,分為九組:自年所得36000元以下,至最高所得組年所得一百萬元以上。實證分析之樣本分三世代:1928年底以前、1929年初~1946年3月底出生及1946年4月~1953年底出生世代。結果:台灣中高齡人口與所得相關死亡率不平等集中於低所得組;例如2003及2007年年齡標準化死亡率CI為-0.1222及-0.1201;RII為-0.7496及-0.7355。相對於年長世代(1928年以前及1929-1946),年輕世代(1946-1953)之與所得相關死亡率不平等程度較大。世代內2007年之不平等比2003年小,亦說明不平等隨著年齡的增加而減少,符合「年齡平準假說」(age-as-leveler hypothesis)。結論:台灣中高齡人口呈現與所得相關之死亡率不平等,而且人口老化促使死亡率呈現年齡平準趨勢。此項趨勢雖可能是死亡選擇的結果,但也顯示若要預防老年人口之健康不平等,除要重視老年人口相關福利政策之制定,似乎亦應關注於從年輕或中年人口所衍伸之健康不平等相關議題。
Objectives: Data from the Survey of Health and Living Status of the Middle-aged and the Elderly in Taiwan and the concentration index (CI) and relative index of inequality (RII) were used to examine inequalities in income-related mortality among the elderly in Taiwan. Methods: Survey data on the 60 and over population in 1999 and 2003 were linked to 2003-2007 data from a national death registry. Participants had been requested to provide information regarding annual income (including that of the respondent and his/her spouse). The income variable included nine categories ranging from below NTD 36000 to 1 million NTD and above. The sample was divided into three birth cohorts: before 1928, 1929-1946, and 1946-1953. Results: Results indicated that mortality was more pronounced among lower income groups of Taiwan's elderly. For example, age-adjusted CIs were -0.1222 and -0.1201 in 2003 and 2007, respectively, while age-adjusted RIIs were -0.7496 and -0.7355, respectively. In 2003, the CIs for the cohorts before 1928 and 1929-1946 were -0.1010 and -0.1301, while the RIIs were -0.6217 and -0.8023. In 2007, the CIs for the cohorts 1928, 1929-1946, and 1946-1953 were -0.0823, -0.0686 and -0.2887, respectively; while the RIIs were -0.5142, -0.4206 and -1.8061. These results indicated that the extent of inequality in mortality in the younger cohort was greater than that in the older cohorts. The decreased inequalities among the cohorts before 1928 and 1929-1946 also supported the age-as-leveler hypothesis. Conclusions: Income-related inequalities in mortality exist among the elderly in Taiwan, but health inequalities increase with age. Policy efforts are needed to reduce the social disparities in health among the elderly and in the young or middle aged as well.
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