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  • 學位論文

社經地位軌跡與中老年人健康之關係

Associations Between Socioeconomic Status Trajectories and Health Outcomes among The Middle-aged and Elderly in Taiwan

指導教授 : 李妙純
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摘要


研究背景:消弭健康不平等現象已蔚為各國之重要政策,台灣也不落人後,在2008年出版之「2020健康國民白皮書」中提到健康政策重要目標之一是「促進國人健康平等」。隨著高齡社會化的來臨,老年人口的健康不平等漸漸受到許多的重視。累積不平等理論(cumulative inequality theory)解釋從生命的孕期開始到晚期所經驗的社會不平等情境,使得每個人的生命軌跡不相同,累積的不平等的結果導致早死、形成健康選擇的現象。過去文獻較少有社會弱勢情境累積及變動軌跡對中老年人健康的影響之研究。 研究目的:本研究目的在分析社會流動軌跡與社會弱勢累積對中老年人之健康影響及健康不平等的意涵。 研究方法:本研究使用國民健康署之「2003年中老年身心社會生活狀況長期追蹤調查」。研究樣本為台灣設籍之50歲以上個人,共計5377人。早期社經地位分以父親職業(分為勞力及非勞力)及受訪者之教育程度(分為國小(含)以下及國中以上)測量,中期社經地位以主要職業類別(分為勞力及非勞力)測量,晚年期則以老年時期之職業(分為勞力及非勞力)及家戶收入(分為年收入三十萬以下及年收入三十萬(含)以上)。勞力職業、未受過正式教育、家戶年收入三十萬元以下設定為弱勢社經地位,亦即社會弱勢者。每一階段曾落入弱勢社經地位則社會弱勢累積量計為一,因此社會弱勢累積量最少為0,最多為3。社經地位軌跡是指上述早期、中期、晚期社經地位的變化情形。測量分別以三階段之職業別以及教育程度-職業-家戶收入軌跡,三階段社經地位變化最後可歸類為八種軌跡。接著使用多元邏輯斯廻歸分析八類軌跡及社會弱勢累積量與中老年人自評健康及憂鬱與否的關係。其他變項包括世代、性別、婚姻、獨居與否、健康行為。 結果與討論:職業軌跡中長期勞力階層者占54%最多,其次是向下流動(非勞力->勞力->勞力)占13%,第三為長期非勞力者占10.53%。教育程度-職業-家戶收入軌跡中向上流動者(低教育->勞力職業->非弱勢家戶收入)最多占35.52%,其次為長期弱勢社經地位者(低教育-勞力職業-弱勢家戶收入)占19.36%,第三為長期非弱勢社經地位者(17.65%)。以職業軌跡來看,長期勞力職業者之自評不健康及憂鬱的勝算皆比長期非勞力者高(OR分別為1.75及1.74)。而且,中年職業為勞力階級者之自評不健康勝算更大(OR=1.96);但早年和晚年職業為勞力階級者之憂鬱勝算較大(OR=1.84)。以教育-職業-家戶收入軌跡而言,相較於長期高社經地位者,長期弱勢社經地位者之自評不健康及憂鬱的勝算較高(OR分別為2.19及2.27)。社會弱勢累積量與自評不健康及憂鬱呈現正相關。分析社經地位軌跡形,可描繪一生的社經地位動態,也可瞭解社經地位的轉換會是否將生命中之風險累積或削減,期待瞭解社會流動與為健康及健康不平等的關係。有助於發展提早介入提升中老年人健康之策略,以縮減社會之健康不平等。

並列摘要


Background: The elimination of health inequalities is an important policy around the world, In Taiwan, "Healthy People 2020" introduced in 2009 set one of the crucial health policy goals is to "improve health equality". Along with the emergence of the aged society, the health inequalities among the elderly population have gradually gained lot of attentions. The “Cumulative Inequality” theory explains that the social-environmental disadvantage experiences over the life course lead to differential life trajectory for everyone. The consequences of cumulative inequality induce premature death among those who experiencing disadvantages across life course. Few studies have focused on the effect of social trajectory and cumulative disadvantages on health outcome among the middle aged and elderly population. Objectives: The purpose of this study is to analyze the effect of social trajectory and cumulative disadvantages over early old age on health outcome among the middle aged and elderly population in Taiwan. Methods: Data for this study came from the 2003’s “Longitudinal Study on Health and Living Status of the Elderly in Taiwan” held by Health Promotion Administration, Ministry of Health and Welfare in Taiwan. The study sample included the individuals of household registration in Taiwan over the age of 50 in 2003, a total of 5,377 respondents. The socioeconomic status (SES) at early age was measured by father's occupational class (manual vs. non-manual occupation) and the education level of the respondents (primary vs. more than primary ).The socioeconomic status at the middle age was measured by the respondent’s major occupational class (manual vs. non-manual occupation). The socioeconomic status at the late age was measured by the occupational class (manual vs. non-manual occupation) and annual household income (below NT$ 300,000 vs. equal or over NT$ 300,000) at the old age. Disadvantaged SESs were defined as respondents who were manual occupations, primary only education level, and annual household income below NT$ 300,000. The accumulation of disadvantaged SES is to count the number of episodes of disadvantaged SES across three stages. Therefore, the cumulative amount ranged from 0 to 3. Socioeconomic status trajectory was measured the change of SES over early, middle and late stage. We generated eight trajectories. Then we used multiple logistic regressions to analyze the relationship between eight trajectories, the cumulative amount of disadvantaged SESs and health outcomes (self-rated health and depression) among the elderly. Control variables included the age cohorts, gender, marital status (married or not), residential arrangement (living alone or not) and health behaviors (drinking and smoking). Results and Discussion: The results demonstrate that the respondents with consistently manual occupational trajectories accounted for 54% of the sample, followed by a downward mobility (non-manual  manual  manual, 13%) and the consistently non-manual occupation trajectory accounted for 10.53% as the third. Moreover, in terms of the educational attainment - occupation - household income trajectories, the respondents with upward mobility (primary education  manual occupation  non- disadvantaged household income) accounted the most of the sample (35.52%), followed by consistently disadvantaged socioeconomic status trajectory (primary education  manual occupation  disadvantaged household income, 19.36%) and the third for the consistently non- disadvantaged socioeconomic status was 17.65%. The logistic regressions show that the odds ratios (ORs) of both poor self-rated health and depression (OR were 1.75 and 1.74, respectively) for consistently manual occupation class were higher than that for consistently non-manual occupation class. Moreover, the OR of poor self-rated health was high (OR = 1.96) when the respondents with manual occupational class at the middle stage, but the OR of depression was 1.84 when the respondents with manual occupational class both early and late stage. In terms of education - occupation - household income trajectory, compared to individuals with consistently non- disadvantaged socioeconomic status trajectory, the odds ratios of poor self-rated health and depression for those in consistently disadvantaged socioeconomic status were higher (OR were 2.19 and 2.27, respectively). The cumulative amount of socially disadvantages was positively correlated with poor self-rated health and depression among the middle-aged and elderly. Analysis of socioeconomic status trajectory can not only depict the dynamics of lifetime socioeconomic status, but also understand whether the transition of socioeconomic status will increase or reduce the effect of socially disadvantages on health outcomes. It is necessary to examine the relationship between the social mobility and health and its implication for policy regarding to reducing health inequalities. The understanding allows us to develop strategies for early interventions in order to reduce health inequalities in the aged society, particularly.

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被引用紀錄


謝佩岑(2016)。以交叉延宕分析探討中高齡者收入與健康之關係〔碩士論文,國立中正大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0033-2110201614044266

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