社經弱勢軌跡與健康結果之關係

目標：本文旨在討論生命歷程社經位置軌跡與老人健康的關係。方法：使用2003年「台灣地區中老年身心社會生活狀況長期追蹤（第五次）調查」資料，設籍台灣之50歲以上，共計5,377人為研究樣本。早、中、晚期社經位置為受訪者之教育程度、一生主要職業、老年時期之家戶收入。國小及以下教育程度、勞力職業、家戶年收入二十九萬元（含）以下定義為社經弱勢。三階段之社經位置變化歸類為八種軌跡。使用多元邏輯斯廻歸分析八類社經弱勢軌跡與中老年人自評不健康及憂鬱與否的關係。其他變項包括年齡、世代、性別、婚姻、獨居與否、健康行為。結果：調整人口社會及健康行為變項之後，相較於長期非社經弱勢者，長期社經弱勢者之自評不健康及憂鬱的勝算較高（OR分別為2.22及2.26）。向上或向下流動者之健康狀態比仍然留在社經弱勢者佳。結論：經歷早期社經弱勢者對健康具有長期負效果，但仍可透過提升生命後期之職業型態或老年時期的收入而減輕。因此，增加任何時期之向上社會流動應有助於消弭健康不平等。

關鍵字

生命歷程；自評健康；憂鬱；社會流動

並列摘要

Objectives: To determine the relationship between social-economic status (SES) trajectory throughout the course of life and health outcomes among the middle-aged and elderly in Taiwan. Methods: Data were based on the 2003 Survey of Health and Living Status of the Middle and Old Age in Taiwan. The study sample included household registrants in Taiwan ＞ 50 years of age in 2003 (5,377 respondents). Three indicators of SES were selected to measure the SES trajectory throughout the course of life, as follows: educational attainment of the respondent; the respondent's major occupational class; and current household income. Social disadvantages were defined as respondents who only had a primary education, manual occupations, and an annual household income＜NT$ 290,000. Eight types of SES trajectories were created by categorizing the patterns of three SES changes (education→occupation→income). Controlled variables included gender, age, cohort, marital status, residential status, and health behavior. Multiple logistic regression was used to analyze the relationship between trajectory and health outcomes, as measured by self-reported poor health and depression. Results: After controlling for sociodemographic variables and health behaviors, long-term social disadvantages had a significantly higher probability of self-reported poor health (OR: 2.22) and depression (OR: 2.26) than nonsocial disadvantages. We further found that respondents with upward and downward mobility at any life stage had a lower probability to report poor health and depression than those who had persistent social disadvantages. Conclusions: The results imply that long-term adverse health consequences of disadvantaged social circumstances in early life may be mitigated by improving employment status in early adulthood and household income in old age. Increasing social mobility contributes to the management of health inequalities among older adults.

並列關鍵字

life-course ； self-reported health ； depression ； social mobility

參考文獻

陳淑美、林佩萱(2010)。親子世代的財務支援、照顧需要對老人居住安排與生活滿意度影響之研究。住宅學報。19，29-58。

林正祥、林惠生(2006)。台灣地區高齡人口存活之相關因素探討。台灣衛誌。25，351-62。

衛生福利部國民健康署：調查簡介 --T L S A 各樣本世代組成與樣本數變化。 http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/TopicArticle.aspx?No=200712270015&parentid=200712270002 。引用2013/12/21 。 Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Introduction to the survey – the composition of each cohort and changes in the sample size in TLSA. Available at: http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/TopicArticle.aspx?No=200712270015&parentid=200712270002. Accessed December 21, 2013. [In Chinese]

Google Scholar

中華民國統計資訊網：國民所得及經濟成長。http://www.stat.gov.tw/ct.asp?xItem=14616&CtNode=3564&mp=4 。引用 2014/03/27 。 National Statistics, R.O.C. (Taiwan). National income and economic growth. Available at: http://www.stat.gov.tw/ct.asp?xItem=14616&CtNode=3564&mp=4. Accessed March 27, 2014. [In Chinese]

Google Scholar

Aittomäki, A,Martikainen, P,Laaksonen, M,Lahelma, E,Rahkonen, O(2010).The associations of household wealth and income with self-rated health - a study on economic advantage in middle-aged Finnish men and women.Soc Sci Med.71,1018-26.