社經弱勢軌跡與健康結果之關係

Social disadvantage trajectories and health outcomes

目標：本文旨在討論生命歷程社經位置軌跡與老人健康的關係。方法：使用2003年「台灣地區中老年身心社會生活狀況長期追蹤（第五次）調查」資料，設籍台灣之50歲以上，共計5,377人為研究樣本。早、中、晚期社經位置為受訪者之教育程度、一生主要職業、老年時期之家戶收入。國小及以下教育程度、勞力職業、家戶年收入二十九萬元（含）以下定義為社經弱勢。三階段之社經位置變化歸類為八種軌跡。使用多元邏輯斯迴歸分析八類社經弱勢軌跡與中老年人自評不健康及憂鬱與否的關係。其他變項包括年齡、世代、性別、婚姻、獨居與否、健康行為。結果：調整人口社會及健康行為變項之後，相較於長期非社經弱勢者，長期社經弱勢者之自評不健康及憂鬱的勝算較高（OR分別為2.22及2.26）。向上或向下流動者之健康狀態比仍然留在社經弱勢者佳。結論：經歷早期社經弱勢者對健康具有長期負效果，但仍可透過提升生命後期之職業型態或老年時期的收入而減輕。因此，增加任何時期之向上社會流動應有助於消弭健康不平等。

Objectives: To determine the relationship between social-economic status (SES) trajectory throughout the course of life and health outcomes among the middle-aged and elderly in Taiwan. Methods: Data were based on the 2003 Survey of Health and Living Status of the Middle and Old Age in Taiwan. The study sample included household registrants in Taiwan > 50 years of age in 2003 (5,377 respondents). Three indicators of SES were selected to measure the SES trajectory throughout the course of life, as follows: educational attainment of the respondent; the respondent's major occupational class; and current household income. Social disadvantages were defined as respondents who only had a primary education, manual occupations, and an annual household income < NT$ 290,000. Eight types of SES trajectories were created by categorizing the patterns of three SES changes (education→occupation→income). Controlled variables included gender, age, cohort, marital status, residential status, and health behavior. Multiple logistic regression was used to analyze the relationship between trajectory and health outcomes, as measured by self-reported poor health and depression. Results: After controlling for socio-demographic variables and health behaviors, long-term social disadvantages had a significantly higher probability of self-reported poor health (OR: 2.22) and depression (OR: 2.26) than non-social disadvantages. We further found that respondents with upward and downward mobility at any life stage had a lower probability to report poor health and depression than those who had persistent social disadvantages. Conclusions: The results imply that long-term adverse health consequences of disadvantaged social circumstances in early life may be mitigated by improving employment status in early adulthood and household income in old age. Increasing social mobility contributes to the management of health inequalities among older adults.