Trajectory Patterns of Self-Rated Health among the Elderly in Taiwan: A Comparison across Ethnicity

台灣老年人口的自評健康軌跡：族群間的比較

董和銳(Ho-Jui Tung)

《人口學刊》 35期 (2007/12) Pp. 113-145

摘要

在台灣的老年人口當中，本省籍與外省籍之間的族群差異是台灣社會階層化的重要面向之一。本研究從生命歷程的觀點出發，利用國民健康局的「台灣老人生活與保健調查」1989到1999年的貫時性調查資料(N=3540)，實證地檢視自評健康的變化軌跡與存活狀況之間的關係。主要的發現有：與大部份老年學的相關文獻一致，自評健康與存活狀況之間存在有很強的相關；在以時間相依(Time-dependent)的自評健康測量進行存活分析時發現，自評健康的變化確實反映受訪老人的健康軌跡；研究結果也發現社會結構變項與不同的健康軌跡型態之間有不同的關聯。就族群間的健康差異而言，本研究結果指出，不同於美國社會黑白之間的族群差異，台灣老年人口中的族群差異似乎可以完全被社經地位變項所解釋（外省籍老人的平均社經地位測量優於本省籍老人）。

關鍵字

台灣 ； 自評健康 ； 存活分析 ； 族群 ； 健康軌跡 ； 老人

並列摘要

This study seeks to compare health trajectories across the two major ethnic groups of the elderly in Taiwan, the Taiwanese and the Mainlanders, over 11 years of follow-up. This ethnic division is considered a salient dimension of social stratification in Taiwan, shaping the two groups of elders' pathways through life. Data are from the first four waves of the Taiwan Survey of Health and Living Status of the Elderly (N=3,540). Proportional hazard models with time-dependent covariates and multinomial logistic regression were employed to compare health trajectories across ethnicity. There are three major findings. (1) Self-rated health is shown to be a remarkably strong predictor of mortality despite controlling for other variables, which is consistent with the bulk of studies in this area. (2) By using a national representative sample of the elderly in Taiwan and treating self-rated health as a time-dependent covariate, evidence from this study reveals that self-rated health reflects a person's health trajectory. (3) Considerable differences exist in the ways socio-structural forces are related to the health trajectories of Mainlanders and Taiwanese, respectively, over the 11 years of follow-up. In conclusion, it seems that, among this elderly population, the ethnic inequality in health can be explained away by Mainlanders' higher socio-economic standing, which is different from the racial/ethnic health disparities observed in the United States, where social class accounts for part of the differences, but the health disparities between African Americans and whites remain after adjusting for measures of social class.

並列關鍵字

Taiwan ； self-rated health ； mortality ； ethnicity ； health trajectory ； elderly

參考文獻

Allison, P. D.(1995).Survival Analysis Using SAS: A Practical Guide.North Carolina:SAS Institute Inc..

Alwin, D. F.,L. A. Wray(2005).A Life-Span Development Perspective on Social Status and Health.Journal of Gerontology Social Sciences.60,7-14.

Bath, P.(2003).Differences between Older Men and Women in the Self-Rated Health-Mortality Relationship.Gerontolgoist.43,387-395.

Benyamini, Y.,T. Blumstein,A. Lusky,B. Modan(2003).Gender Differences in the Self-Rated Health-Mortality Association: Is It Poor Self-Rated Health that Predicts Mortality or Excellent Self-Rated Health that Predicts Survival?.Gerontolgoist.43,396-405.

Chen, W. C.(2005).Ethnicity, Gender, and Class: Ethnic Differences in Taiwan`s Educational Attainment Revisited.Taiwanese Sociology.10,1-40.