目的:了解地區社經因素和個人社經地位對健康的影響程度。 研究設計與對象:橫斷式研究設計。利用政府出版資料進行多層次分析,共分成兩個階層,個人階層與地區階層。個人階層變項為教育程度、職業和平均月收入,資料來源為「民國91年臺灣地區國民健康促進知識、態度與行為調查」資料庫,代表性樣本共24120名,來自臺灣23個縣市,20歲以上成年人口;地區階層的控制變項,根據文獻回顧找出四個縣市指標(失業率、15歲以上高等教育比率、政府社會福利支出和家戶可支配所得),經由Z值轉換計算成地區社經指標,將臺灣23個縣市分成三組進行比較,資料來自行政院主計處的「各縣市重要指標統計」資料庫。 結果:有14.0%的臺灣成人自評健康差。透過對數複迴歸同時放入地區社經因素、個人社經地位和其他控制變項,發現在控制個人社經地位後,地區社經因素對自評健康的影響仍達顯著水準。利用多層次分析探討地區社經因素與個人社經地位對自評健康之影響,ICC之結果為11.05%,表示自評健康的差異有11.05%可被地區間差異解釋,而且於控制個人層次變項後,仍顯示地區社經差異對自評健康有影響,以教育程度當指標,居住在低社經地區比居住在高社經地區自評健康差的風險為1.26 (p<0.05);以收入當指標,居住在低社經地區比居住在高社經地區自評健康差的風險為1.35 (p=0.065)。而個人社經地位對自評健康的影響呈現梯度關係,以教育指標為例,教育程度為大專及以上者視為參考組,自評健康差的風險分別為不識字者的3.95(p<0.0001)、國中以下者的2.30 (p<0.0001)和高中程度者的1.53(p<0.001);以收入指標為例,收入在二萬至四萬元以下者視為參考組,自評健康差的風險分別為沒有收入者的2.15 (p<0.0001)、一萬元以下者的2.23 (p<0.0001)、一萬至二萬元以下者的1.61 (p<0.05)和四萬元以上者的0.62 (p<0.05)。 結論:個人社經地位與地區社經因素對自評健康皆有顯著影響,即使在控制了個人社經地位後,地區社經因素仍對自評健康有顯著效果。然地區社經因素會透過跨層級交互作用,擴大「個人社經地位對自評健康的差距」。即居住在低社經地區,低教育或低收入對自評健康的影響會被擴大。於政策意涵上,政府應弭平地區間的社經差異,避免擴大自評健康的差異。
Objective: The purpose of this study is to examine the association of community- and individual-level socioeconomic status, and self-rated health in Taiwan. Design and Participants: Data for the study came from the 2002 National Survey of Taiwan on Knowledge, Attitude, and Practice of Health Promotion, consisting representative sample of 24120 people aged 20 and over in 23 cities and countries. Individual-level socioeconomic characteristic was measured by educational attainment, occupation, and income per month. The socioeconomic characteristic of community was measured using a mixed index. Results: 14.0% of adults reported poor health in Taiwan. In multi-level model, community- and individual-level socioeconomic status were both associated with self-rated health. The ICC indicator was 11.05%, meaning there were 11.05% of variances can be explained by community-level differences. We also found community-level effects on self-rated health even after adjusting for individual-level socioeconomic status. For example, the odds ratio for poor self-rated health was 1.26 who living in the lowest community compared with people living in the highest community. Conclusion: Although both level factors were associated with health, individual-level socioeconomic status was more powerful than community-level socioeconomic status. However, community-level socioeconomic status will medicate the effect of individual-level socioeconomic status on self-rated health.