兒童貧窮與兒童健康：長期追蹤研究

Child Poverty and Children’s Health: A Longitudinal Study

江宛霖(Wan-Lin Chiang)

指導教授 ： 江東亮

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2017年)

https://doi.org/10.6342/NTU201700472

摘要

背景與目的：雖然社會越來越關注貧窮與兒童健康的關係，但是兒童經歷長期貧窮的影響卻仍缺乏深入研究。本研究旨在利用臺灣出生世代研究的長期追蹤資料，探討兒童從出生到學齡期的貧窮經驗與其八歲時健康的關係；具體而言，有三個目的：（1）檢視貧窮對兒童健康的影響；（2）分析兒童貧窮的決定因素；及（3）了解早期貧窮影響兒童健康的機轉。
方法：本研究分析資料來自臺灣出生世代研究，該調查係以2005年全國出生嬰兒為母群體，採兩階段分層隨機抽樣方法，共抽出24,200名樣本。本研究以完成6個月、18個月、3歲、5.5歲及8歲等五波調查，且有完整收入資料的兒童為研究對象，計17,853名。主要研究自變項為貧窮―兒童父母最近一年平均每個月收入小於3萬元，其中，5歲之前的貧窮經驗稱為早期貧窮，而8歲時貧窮狀況稱為當期貧窮。我們進一步將早期貧窮經驗分成：持續貧窮、有時貧窮與從未貧窮三組。依變項為兒童8歲時母親對其健康狀況的評估；中介變項包括物質因素、教養方式，及兒童健康行為；貧窮決定因素則分為父母特徵與家庭特徵兩大類。
結果：17,853位樣本兒童中，23.6%在5歲以前曾經歷貧窮（其中，5.9%是持續貧窮，17.7%是有時貧窮），11.4%則在8歲時處於貧窮（當期貧窮）。研究結果顯示：（1）兒童只要曾經歷貧窮，其8歲健康皆比從未經歷貧窮的兒童不好，而5歲前的早期貧窮經驗對兒童健康的影響（持續貧窮：OR=1.50, 95% CI 1.27-1.78；有時貧窮：OR=1.25, 95% CI 1.12-1.39）比8歲當期貧窮（OR=1.23, 95% CI 1.09-1.40）顯著，並且早期貧窮期間越長，兒童的健康越差；（2）關於貧窮的決定因素，父母工作狀態與父母最高教育程度是造成兒童持續貧窮的最重要原因，而生長在年輕母親、外籍母親、單親或鄉下地區的家庭中的兒童，也比較有可能經歷貧窮；（3）關於早期貧窮與兒童健康的機轉，物質因素、教養方式，及兒童健康行為皆為重要的中介變項。其中，教養方式的間接效果最大。
結論：本研究發現，貧窮顯著影響兒童的健康，特別是經歷貧窮的時間越早或越長，兒童的健康狀況都越差。因此，政府不僅要針對致貧因素採取行動以降低兒童貧窮率，並且要確保貧窮兒童能獲得必要的物質生活條件、適當的教養，以及健康的生活方式，以減少貧窮對兒童健康的傷害。

關鍵字

兒童貧窮 ； 持續貧窮 ； 早期貧窮 ； 當期貧窮 ； 兒童健康 ； 出生世代研究

並列摘要

Objectives: There are growing concerns about effects of poverty on children’s health, but few studies have examined how experience of long-term poverty affects the health of children. We intend to investigate the relationship between the children’s experience of poverty from birth to school age and their health at age 8 in Taiwan. In specific, this study has three objectives: (1) to examine the association between poverty and children’s health; (2) to identify the risk factors for child poverty in Taiwan; and (3) to analyze the mechanisms that link early poverty and children’s health.
Methods: Data for the analysis are obtained from the Taiwan Birth Cohort Study, the first large-scale longitudinal study of children in Taiwan. Initially, a nationally representative cohort of 24,200 babies born in 2005 was drawn from the National Birth Report Database by two-stage stratified random sampling. Five waves of follow-up surveys were conducted at 6 months, 18 months, 3 years, 5.5 years, and 8 years of age. There are two criteria for inclusion in this study’s sample: completion of the five waves of TBCS interview surveys between 2005 and 2013, and respondents had available data for their poverty histories. The resulting sample size was 17,853 children. Child poverty, the primary independent variable of this study, was defined as a monthly parental income of less than $30,000 NTD. On the basis of each family's history of poverty, we used two features of poverty: timing and duration, to account for poverty dynamics. The timing of poverty was divided into early poverty (before age 5) and concurrent poverty (at age 8). Further, the early poverty was grouped into three types: persistent poverty, occasional poverty, and never poverty. The primary outcome variable was the mother-rated health of children at age 8. The mediators considered were material factors, parenting, and health behaviors of children. The risk factors for child poverty were divided into two groups: parental characteristics and family characteristics.
Results: Of the 17,853 cohort members, 23.6% experienced early poverty (5.9% experienced persistent poverty, 17.7% experienced poverty some time in their life), and 11.4% experienced poverty at age 8. The results show that: (1) Children born and growing in poverty families were more likely to have poor health than those who were of never poverty group. Early poverty before age 5 (persistent poverty: OR=1.50, 95% CI 1.27-1.78; occasional poverty, OR=1.25, 95% CI 1.12-1.39) was more detrimental to children’s health than concurrent poverty at age 8 (OR=1.23, 95% CI 1.09-1.40), particularly those in persistent poverty. (2) Early child poverty was significantly associated with families experiencing chronic unemployment, parents with low educational attainment, mothers having the child before age 25, foreign-born mothers, single-parent families and residence in rural areas. Of these factors, parental employment status and the educational level of parents were the most important determinants of early child poverty. (3) The relationship between early poverty and children’s health was mediated by material factors, parenting, and health behaviors of children, and parenting was the most important mediator.
Conclusions: This study suggests that poverty has pervasive impacts on children’s health, particularly those in early poverty or persistent poverty. Thus, government should not only tackle the causes of child poverty to reduce the child poverty rate, but also ensure that poor children live in homes with material conditions necessary for living, good parenting, and healthy living practices to mitigate the adverse effects of poverty on children’s health.

並列關鍵字

child poverty ； persistent poverty ； early poverty ； concurrent poverty ； child health ； birth cohort study

參考文獻

Wang, Y. T. (2005). An analysis on poverty of families with foreign/Chinese spouses in Taiwan, Taiwanese Social Work, 4, 1–32.

江宛霖、江東亮（2016）。台灣全民健康保險的減貧效果。台灣衛誌；35：164–71。

江宛霖、江東亮（2016）。台灣縣市兒童貧窮與死亡率之關係：1980-2009年。台灣衛誌；35：260–7。

李秀如、王德睦（2008）。多面向的臺灣兒童貧窮趨勢：SST 指標的應用及分解。臺大社會工作學刊；18：191–229。

薛承泰（2008）。台灣地區兒少貧窮: 1991-2005 年的趨勢研究。臺灣社會學刊；40：89–130。