以交叉延宕分析探討中高齡者收入與健康之關係

A Cross-lagged Analysis of the Relationships Between Income and Health Among Middle-aged and Older Adults in Taiwan

謝佩岑(Pei-Cen Sie)

指導教授 ： 李妙純

國立中正大學/社會科學院/社會福利學系/碩士(2016年)

摘要

研究背景：隨著高齡社會的來臨，老年健康的議題已成為社會政策所關注的重點之一。在生命歷程中，中高齡者會經歷各種社會風險因子，而這些社經因素會透由直接或間接方式影響他們的健康，因此形塑高齡者的健康狀況。然而，過去研究較多關注於當下社經因素與健康間的關係，所以無法理解兩者長期性的趨勢，且關於中高齡者社經因素軌跡及健康軌跡之縱貫性研究較少。
研究目的：本研究旨在探討台灣中高齡者收入與健康間之動態關係及交互影響。
研究方法：採用「中老年身心社會生活狀況長期追蹤調查系列」資料進行實證分析，包含1989年、1993年、1996年、1999年、2003年及2007年，共六波的調查資料。社經因素以收入十分位為測量，以自評健康及生活滿意度為健康指標。本研究除了繪製中高齡者收入及健康之軌跡外，並運用交叉延宕長期追蹤模型檢視社經因素與健康間的交互影響關係。控制變項包括性別與年齡。
結果：排除遺漏值及死亡樣本，本研究分析樣本為4,393男性及3,717女性。收入的軌跡可分為五組：持續高(25.8%)、持續中低(16.7%)、漸減(32.2%)、早期減少(12.7%)、持續低(12.6%)；自評健康軌跡亦歸類五組：持續良好(30.3%)、持續不佳(2.3%)、持續普通(35.9%)、漸差(10.3%)、普通變差(21.2%)；生活滿意度具有四組軌跡：持續高度(71.7%)、中度上升(9.3%)、早期變差(9.2%)、晚期變差(9.8%)。交叉延宕分析結果顯示，收入、自評健康及生活滿意度間存在自我廻歸效果及交互效果；相較於自評健康(0.36－0.43)及生活滿意度(0.27－0.34)，收入(0.46－0.56)的自我廻歸效果較大；且收入對自評健康(0.09－0.12)以及生活滿意度(0.08－0.13)的交互效果比起自評健康(0.03－0.09)及生活滿意度(0.04－0.08)對收入的交互效果來得大。
結論：本研究結果證實中高齡者收入與健康間存在路徑效果，包括生物路徑、社會－生物路徑、生物－社會路徑與社會路徑，以及累積效果。亦即，收入與健康之關係除了社會因果機制外，仍存在社會選擇的現象，中高齡者可能由於健康因素提早退休或醫療支出增加，造成收入減少，可見不管哪一時期，健康都是重要的人力資本。此外，雖然中高齡者之收入軌跡多數(45%)為社會向下流動，但仍有大部分(72%)中高齡者的生活滿意度呈現持續高的狀態。因此，對於了解中高齡者之健康福祉應不僅關注於失能、慢性病等疾病面向，更應聚焦於主觀自覺的整體生活品質，以利有效適當分配資源，並提升中高齡者之整體健康福祉。

關鍵字

生活滿意度 ； 自評健康 ； 生命歷程 ； 軌跡

並列摘要

Background: With the coming of an aged-society, health of older people has become an increasing urgent social policy. Older people has being experienced a variety of social risk factors throughout their life courses. These social risk factors might influence directly and indirectly health in their later life. However, many previous studies have focused on the concurrent relationship between socioeconomic factors and health that therefore have overlooked their longitudinal relationship. Studies on longitudinal relationship between socioeconomic factors and health among the older people is scarce, particularly trajectory analyses.
Aim: The purpose of this study is to analyze the dynamic relationship and the interaction effects between income and health among the older people in Taiwan.
Method: This study used the six wave data of the “Longitudinal Study on Health and Living Status of the Elderly in Taiwan” (1989、1993、1996、1999、2003、2007). Socioeconomic factors were measured by income deciles, while health was measured by self-rated health and life satisfaction. A group-based trajectory modeling approach was employed to create trajectories. Cross-lagged longitudinal models were employed to examine the cross-lagged effects of income and health.
Results: The final sample comprises 4,393 male and 3,717 female. Five income trajectories were created: consistently high (25.8%), moderately low (16.7%), decreasing (32.2%), early decreasing (12.7%), and consistently low (12.6%). Four trajectories of self-rated health included consistently good (30.3%), consistently poor (2.3%), moderately (35.9%), decreasing (10.3%), and moderately to poor (21.2%). Four trajectories of life satisfaction included: consistently high (71.7%), increasing (9.3%), early decreasing (9.2%), and late decreasing (9.8%). The results of cross-lagged analysis showed that the autoregressive coefficients of income(0.46－0.56) were greater than that of self-rated heath(0.36－0.43)and life satisfaction(0.27－0.34). The cross lagged coefficients of income on self-rated health(0.09－0.12) and life satisfaction(0.08－0.13) were greater than that of self-rated health(0.03－0.09)and life satisfaction(0.04－0.08) on income, respectively.
Conclusions: The results have provided evidence on the several pathways between income and health, including biological, socio-biological, bio-social, and social and accumulation effect. That is, in addition to social causality of income on health, the social selection effect could not be neglected. This is because that poor health leads to low income due to induced early retirement or increased health care costs. It is obvious that health is an important human capital in any life course. Moreover, the majority of the older people (45%) were grouped as a downward income trajectory, but most of them (72%) have demonstrated a consistently high pattern of life satisfaction. Therefore, in order to fully understand health and well-being of older people, policies should not only be targeted on illness, disability or chronic diseases, but also be concentrated on the subjective self-perceived quality of life. The understanding will facilitate to the appropriately resource allocation and thus leads to the improvement of well-being and overall health of older people.

並列關鍵字

self-rated health ； life course ； trajectories ； life satisfaction

參考文獻

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