本文選題：兒童期 + 社會(huì)經(jīng)濟(jì)地位　； 參考：《山東大學(xué)》2014年博士論文

【摘要】：研究背景 大量研究發(fā)現(xiàn)利用收入、教育或職業(yè)衡量的不同社會(huì)階層中,健康是不平等分布的。早期關(guān)于健康的社會(huì)經(jīng)濟(jì)梯度的研究集中于闡述這些梯度的存在,很少去研究社會(huì)經(jīng)濟(jì)梯度背后的原因。理論模型和實(shí)證研究都致力于解釋成年期出現(xiàn)健康差異的原因,但沒有一個(gè)因素,無論是單獨(dú)的還是結(jié)合的,能完全地解釋健康的社會(huì)經(jīng)濟(jì)梯度。研究者認(rèn)為,社會(huì)經(jīng)濟(jì)地位對(duì)健康的影響并非是一時(shí)的,而是持續(xù)的、累積的,人生早期的生活經(jīng)歷會(huì)對(duì)未來健康產(chǎn)生長(zhǎng)遠(yuǎn)的影響。在生命周期的各個(gè)階段中,兒童期非常關(guān)鍵。兒童期的社會(huì)經(jīng)濟(jì)地位以及生活環(huán)境對(duì)成年期社會(huì)經(jīng)濟(jì)地位以及疾病風(fēng)險(xiǎn)有著長(zhǎng)期的影響,這種影響將可能持續(xù)一生。 近年來研究者開始關(guān)注兒童期的社會(huì)經(jīng)濟(jì)地位與成年期健康以及長(zhǎng)壽的關(guān)系,致力于從源頭探究健康差異。現(xiàn)有的相關(guān)研究主要集中在歐美等發(fā)達(dá)國(guó)家,來自發(fā)展中國(guó)家的研究非常有限。多數(shù)研究的健康指標(biāo)集中在死亡率以及心血管疾病,部分文獻(xiàn)利用了比較單一的健康指標(biāo)如自評(píng)健康、認(rèn)知功能等,全面綜合地從生理、心理等方面評(píng)價(jià)中老年人健康狀況的研究較少,并且在使用不同的指標(biāo)以及在不同地區(qū)的人群中開展研究的時(shí)候,得出的結(jié)論并不一致。我國(guó)作為發(fā)展中國(guó)家,社會(huì)經(jīng)濟(jì)水平、人們的健康狀況、行為生活方式和發(fā)達(dá)國(guó)家相比都存在較大差異。并且,我國(guó)中老年人的生活軌跡可能更為復(fù)雜,不可避免地會(huì)影響到中老年群體的兒童期及當(dāng)前的社會(huì)經(jīng)濟(jì)地位,進(jìn)而對(duì)健康狀況造成影響。 研究目的 本研究的總目標(biāo)是通過理論研究和實(shí)證分析,探討兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康的關(guān)系以及生命歷程里社會(huì)經(jīng)濟(jì)地位的變動(dòng)對(duì)中老年健康狀況的影響,為減少健康差異、促進(jìn)健康公平政策的制定提供理論基礎(chǔ)和科學(xué)依據(jù)。 具體研究目的包括：構(gòu)建兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康關(guān)系的理論和實(shí)證模型；揭示兒童期社會(huì)經(jīng)濟(jì)地位與中老年自評(píng)健康、日�；顒�(dòng)能力、認(rèn)知功能、抑郁癥狀等健康指標(biāo)之間的關(guān)系；探討社會(huì)經(jīng)濟(jì)地位的變動(dòng)對(duì)中老年健康狀況的影響；分析兒童期社會(huì)經(jīng)濟(jì)地位、兒童期健康、中老年期社會(huì)經(jīng)濟(jì)地位及中老年健康之間的相互關(guān)系；提出減少健康差異、促進(jìn)健康公平的政策建議。 研究方法 本研究數(shù)據(jù)來源于“中國(guó)健康與養(yǎng)老追蹤調(diào)查(CHARLS)"2011-2012年全國(guó)基線調(diào)查,CHARLS的抽樣方法為多階段分層概率比例規(guī)模抽樣。最終抽取28個(gè)省(直轄市),150個(gè)縣(區(qū)),450個(gè)行政村(社區(qū)),本文的研究對(duì)象為參與問卷調(diào)查及體檢的45歲及以上的中老年人,刪除關(guān)鍵變量缺失及異常值的樣本,本研究最終納入的家戶數(shù)為8520,樣本量為13516。 在分析方法上,本研究首先對(duì)樣本的基本情況以及社會(huì)經(jīng)濟(jì)特征進(jìn)行了描述和比較；然后利用單因素和多因素分析探討了兒童期社會(huì)經(jīng)濟(jì)地位與不同健康指標(biāo)的關(guān)系,通過構(gòu)建Logistic回歸模型,在模型中逐步納入兒童期社會(huì)經(jīng)濟(jì)地位、兒童期健康、中老年期社會(huì)經(jīng)濟(jì)地位,分析逐步控制上述因素后模型的變化；隨后通過主成分分析構(gòu)建兒童期社會(huì)經(jīng)濟(jì)地位及中老年期社會(huì)經(jīng)濟(jì)的綜合指標(biāo),分析生命歷程里社會(huì)經(jīng)濟(jì)地位的變動(dòng)與健康狀況的關(guān)系；最后是構(gòu)建PLS路徑分析模型,探討了兒童期社會(huì)經(jīng)濟(jì)地位、兒童期健康、中老年期社會(huì)經(jīng)濟(jì)地位以及不同健康指標(biāo)之間的關(guān)系。資料的統(tǒng)計(jì)分析由SPSS16.0軟件和Smart PLS2.0軟件完成。 主要研究結(jié)果 (1)兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康狀況的關(guān)系 研究對(duì)象自評(píng)健康為很好、好、一般、不好、很不好的比例分別為6.9%、15.3%、47.7%、27.4%和2.6%,日�；顒�(dòng)能力的受損率為16.8%,抑郁癥狀的發(fā)生率為37.7%,高血壓的患病率為40.9%,認(rèn)知均分為12.73分。除了高血壓患病之外,單因素分析均顯示,兒童期SES處于劣勢(shì)的研究對(duì)象,中老年期的健康狀況較差。在多因素分析中,控制了中老年當(dāng)前的SES之后,兒童期SES與自評(píng)健康、日常活動(dòng)能力受損、抑郁癥狀以及高血壓患病的關(guān)系消失,但與認(rèn)知功能的關(guān)系存在統(tǒng)計(jì)學(xué)意義,兒童期居住于城鎮(zhèn)、父母親接受過教育的研究對(duì)象,中老年期的認(rèn)知功能更好。 (2)兒童期到中老年期社會(huì)經(jīng)濟(jì)地位的變動(dòng)與中老年健康狀況的關(guān)系 研究對(duì)象的年齡、婚姻狀況以及地區(qū)不同,兒童期SES綜合得分存在差異(P0.001),低齡、在婚、東中部的研究對(duì)象,兒童期SES綜合得分較高；研究對(duì)象的性別、年齡、婚姻狀況以及地區(qū)不同,中老年期SES的綜合得分存在差異(P0.001),男性、低齡、在婚、東部的研究對(duì)象,中老年期SES的綜合得分較高。研究對(duì)象從兒童期到中老年期SES的變動(dòng)“保持低水平”、“由高到低”、“由低到高”、“保持高水平”的比例分別為37.4%、12.6%、21.6%和28.4%。低齡組、在婚組“保持高水平”的比例更高,和男性相比,女性的社會(huì)經(jīng)濟(jì)地位更難上升。SES變動(dòng)形式不同,自評(píng)健康不良率、ADL受損率、高血壓患病率、抑郁癥狀發(fā)生率、認(rèn)知功能均存在統(tǒng)計(jì)學(xué)差異。兒童期SES較低但經(jīng)歷了SES上升的研究對(duì)象與SES未經(jīng)歷上升的相比,健康狀況更好；相反,兒童期SES較高但后期經(jīng)歷了SES下降的研究對(duì)象與未經(jīng)歷SES下降的相比,健康狀況更差。但高血壓患病未呈現(xiàn)類似的變化趨勢(shì),SES“保持高水平”的研究對(duì)象高血壓患病風(fēng)險(xiǎn)最高,“保持低水平”的患病風(fēng)險(xiǎn)最低。 (3)兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康關(guān)系的路徑分析 所有的PLS路徑模型均顯示,兒童期SES與中老年SES的標(biāo)準(zhǔn)化路徑系數(shù)最大,兒童期SES越高,中老年期SES越高；兒童期SES越高,兒童期健康狀況越好；兒童期健康狀況越好,中老年SES越高；中老年SES越高,自評(píng)健康越好,日�；顒�(dòng)能力受損越小,抑郁癥狀發(fā)生風(fēng)險(xiǎn)越低,認(rèn)知功能越好。兒童期SES與不同健康指標(biāo)的關(guān)系有差異,兒童期SES對(duì)中老年認(rèn)知具有直接影響,兒童期SES越高,中老年期認(rèn)知功能越好,但與其他健康指標(biāo)的關(guān)系,未見統(tǒng)計(jì)學(xué)意義,兒童期SES與其他健康指標(biāo)的關(guān)系更多是通過兒童期健康及中老年SES的間接作用。另外,兒童期健康與不同健康指標(biāo)的關(guān)系也有差異,兒童期健康狀況越好,中老年自評(píng)健康越好,抑郁癥狀發(fā)生風(fēng)險(xiǎn)越低,但與ADL、高血壓患病以及認(rèn)知功能的關(guān)系未見統(tǒng)計(jì)學(xué)意義。 結(jié)論及建議 根據(jù)研究結(jié)果,本研究得出如下結(jié)論： (1)兒童期SES對(duì)中老年健康具有長(zhǎng)遠(yuǎn)的影響,兒童期SES處于劣勢(shì),會(huì)增加中老年健康狀況不良的風(fēng)險(xiǎn)。但對(duì)于不同的健康指標(biāo),這種關(guān)系的強(qiáng)度不一樣,對(duì)于自評(píng)健康、日�；顒�(dòng)能力、高血壓患病和抑郁癥狀,主要是通過兒童期健康及中老年當(dāng)前的社會(huì)經(jīng)濟(jì)地位發(fā)揮中介作用,證實(shí)了“路徑模型”；對(duì)于認(rèn)知功能,則更多體現(xiàn)了兒童期SES直接的作用,證實(shí)了“累積劣勢(shì)模型”。(2)兒童期到中老年期SES上移,能部分補(bǔ)償兒童期不良SES的負(fù)面影響,兒童期到中老年期SES下移,早期良好SES的影響會(huì)被下移的SES所抵消。(3)兒童期SES處于劣勢(shì)的研究對(duì)象,中老年期SES更為低下。社會(huì)經(jīng)濟(jì)地位具有代際轉(zhuǎn)移的特點(diǎn),證實(shí)了“地位獲得模型”。(4)兒童期健康狀況不良的研究對(duì)象,中老年期SES更為低下,體現(xiàn)在受教育程度和家庭人均收入較低,驗(yàn)證了“健康選擇學(xué)說”。(5)兒童期健康狀況不良,中老年期的自評(píng)健康較差,日常活動(dòng)能力和抑郁癥狀發(fā)生率較高,人生早期的健康狀況產(chǎn)生長(zhǎng)遠(yuǎn)影響,甚至持續(xù)終身。(6)研究對(duì)象當(dāng)前的社會(huì)經(jīng)濟(jì)地位對(duì)健康具有重要影響�，F(xiàn)居地為農(nóng)村、受教育程度低、家庭人均收入低的研究對(duì)象,自評(píng)健康狀況較差,日�；顒�(dòng)能力受損較嚴(yán)重,抑郁癥狀發(fā)生率較高,認(rèn)知功能較為低下。因此,縮小社會(huì)經(jīng)濟(jì)地位的差異有助于降低健康不平等。 上述結(jié)論具有如下政策含義(1)重視兒童期社會(huì)經(jīng)濟(jì)地位對(duì)整個(gè)生命歷程的長(zhǎng)遠(yuǎn)影響,將兒童期作為生命歷程里降低健康差異的最佳時(shí)機(jī)�？s小社會(huì)經(jīng)濟(jì)地位的差異,不僅能縮小當(dāng)前的健康差異,而且對(duì)未來健康產(chǎn)生潛在的長(zhǎng)遠(yuǎn)影響。(2)改善健康狀況,促進(jìn)健康公平,不僅僅依賴于個(gè)人當(dāng)前的社會(huì)經(jīng)濟(jì)地位或衛(wèi)生服務(wù)因素,還有賴于早期的生活經(jīng)歷和健康狀況。意味著完善衛(wèi)生系統(tǒng)內(nèi)的舉措只是解決衛(wèi)生服務(wù)本身的問題,要增進(jìn)健康,促進(jìn)公平,不僅需要相對(duì)完善的衛(wèi)生服務(wù),更需著力破解衛(wèi)生系統(tǒng)之外的諸多問題。要將其置于一個(gè)宏觀的社會(huì)經(jīng)濟(jì)制度的框架下綜合考慮,注重縮小城鄉(xiāng)社會(huì)經(jīng)濟(jì)差異、教育差異。 創(chuàng)新與不足 本研究的創(chuàng)新性(1)現(xiàn)有的關(guān)于兒童期社會(huì)經(jīng)濟(jì)地位與成年健康的研究主要集中在歐美國(guó)家,本研究利用我國(guó)大規(guī)模的調(diào)研數(shù)據(jù),基于生命歷程理論,從生理、心理、認(rèn)知功能等方面全面探討兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康狀況的關(guān)系,提供來自我國(guó)的證據(jù)。(2)通過構(gòu)建綜合性的社會(huì)經(jīng)濟(jì)地位指標(biāo),探討了生命歷程里社會(huì)經(jīng)濟(jì)地位的變動(dòng)對(duì)健康狀況的影響,彌補(bǔ)了國(guó)內(nèi)該方面研究的不足。(3)構(gòu)建PLS路徑分析模型,對(duì)兒童期SES、兒童期健康、中老年SES以及中老年健康之間的關(guān)系進(jìn)行了系統(tǒng)分析,有利于為減小健康差異、促進(jìn)公平的政策制定找到干預(yù)點(diǎn)。 本研究的不足(1)只掌握了有限的兒童期信息,兒童期到中老年的時(shí)間跨度大,且利用的是橫斷面數(shù)據(jù),本研究只是對(duì)兒童期社會(huì)經(jīng)濟(jì)地位與中老年健康之間的關(guān)系進(jìn)行了探討,難以確定因果關(guān)系的方向。(2)對(duì)于兒童期社會(huì)經(jīng)濟(jì)地位低下的個(gè)體來說,可能在進(jìn)入中年之前就已經(jīng)去世,被排除在本研究的樣本之外,可能導(dǎo)致一定的樣本選擇偏倚。(3)社會(huì)經(jīng)濟(jì)地位的測(cè)量只包括兩個(gè)時(shí)點(diǎn),而出生時(shí)的情況及中期之前的工作收入等都有可能影響健康狀況,由于數(shù)據(jù)的限制,并未考慮這一影響,有可能影響研究結(jié)論。
[Abstract]:Background of the study

A large number of studies have found that health is not equally distributed among different social strata measured by income , education or occupation . Early research on healthy socio - economic gradients focuses on explaining the causes of health disparities in adulthood , but there is no one factor , whether alone or in combination , a long - term impact on the future health . In all stages of the life cycle , children ' s life is critical . The socio - economic status of the children ' s period and the life environment have a long - term impact on the socio - economic status of adulthood and the risk of disease .

In recent years , researchers have focused on the relationship between the socio - economic status of childhood and the health of adulthood and long - life , and are committed to exploring health differences from the source . The existing research focuses mainly on developed countries such as Europe and America , and the conclusions are not consistent . In China , as a developing country , social and economic levels , people ' s health status , behavioral life style and developed countries , there are significant differences .

Purpose of study

The main objective of this study is to study the relationship between the social and economic status of childhood and the health of middle - aged and old - aged and old people through theoretical research and empirical analysis , and to provide theoretical basis and scientific basis for the development of health equity policy in order to reduce health disparities and promote healthy and fair policies .

The purpose of this study is to build a theoretical and empirical model of the relationship between the social and economic status of childhood and the healthy relationship between the aged and the aged ;
To reveal the relationship between the socio - economic status of childhood and the health indicators , such as health , daily activity , cognitive function and depression .
To explore the influence of changes of socioeconomic status on health status of middle - aged and old people ;
To analyze the relationship between the social and economic status of childhood , the children ' s health , the socioeconomic status of the middle and old age and the health of middle - aged and aged people ;
A policy proposal to reduce health disparities and promote healthy and equitable health is proposed .

Research Methods

The data of this study was derived from the National Baseline Survey of China ' s Health and Old Age Trace ( CHARLS ) 2011 - 2012 . The sampling method of CHARLS is the sampling of multi - stage stratified probability scale . In the end , 28 provinces ( municipalities directly under the Central Government ) , 150 counties ( districts ) and 450 administrative villages ( communities ) are drawn . The study objects in this paper are samples of middle - aged and old people aged 45 and above who participate in the questionnaire and physical examination , delete the missing and abnormal values of key variables , and the total number of households in this study is 8520 , and the sample size is 13516 . Based on the analysis method , the basic condition of the sample and the social and economic characteristics are described and compared . Then , the relationship between the socioeconomic status of childhood and the different health indicators is discussed by means of single factor and multi - factor analysis . The relationship between the change of social and economic status and the health status in the life course is analyzed by constructing the Logistic regression model . Finally , the relationship between the social and economic status , the children ' s health , the social and economic status of the middle and the old age and the different health indicators is analyzed through the analysis of principal component . The statistical analysis of the data is completed by SPSS 16.0 software and Smart PLS2 . 0 software . Primary Study Results ( 1 ) Relationship between socio - economic status and health status of middle - aged and aged people in childhood In addition to the prevalence of hypertension , SES and self - assessment health , the prevalence of depressive symptoms and hypertension were 40.9 % , 15.3 % , 47.7 % , 27.5 % and 2.6 % , respectively . ( 2 ) The relationship between the changes of social economic status and the health status of middle - aged and old age in childhood to middle and old age The age , marital status and difference of SES in children were different ( P0.001 ) , low age , early marriage and middle aged SES , and the comprehensive score of SES in children was higher . The proportion of SES changed from childhood to mid - aged SES was higher than that of male , and the proportion of female ' s social and economic status was higher than that of men . The proportion of SES varied , self - rating health bad rate , ADL vulnerability , hypertension prevalence , depression incidence and cognitive function were statistically different .
In contrast , there was a higher incidence of SES in children with SES but a worse health condition compared to those who did not experience a decline in SES . However , hypertension did not exhibit similar trends , and SES " maintained a high level " of study subjects had the highest risk of hypertension and the lowest risk of " maintaining a low level " .

( 3 ) Path analysis of the relationship between socio - economic status and health of middle - aged and old people in childhood

All PLS path models show that the standardized pathway coefficients of SES and SES in children are the largest , the higher the SES of SES , the higher the SES of SES .
The higher the children ' s SES , the better the children ' s health status ;
The better the children ' s health status , the higher the SES of middle - aged and old - aged SES ;
Compared with other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the relationship between SES and other health indicators , the better the children ' s health status , the better the self - assessment health of middle - aged and old age , the lower the risk of depressive symptoms , but no statistical significance with ADL , hypertension and cognitive function .

Conclusions and recommendations

Based on the results of the study , this study concludes with the following conclusions :

( 1 ) Children ' s SES has a long - term effect on the health of middle - aged and old people , and SES is at a disadvantage in childhood , which can increase the risk of poor health status of middle - aged and old people . But for different health indicators , the intensity of this relationship is different . For self - evaluation health , daily activity , hypertension and depression , the " path model " is confirmed mainly through the intermediary role of current social and economic status of childhood health and middle - aged and old age .
( 3 ) Children ' s period to middle and old age SES moves upward , can partially compensate for children ' s bad SES ' s negative effect , children ' s period to middle and old age SES moves down , the influence of early good SES can be offset by SES . ( 3 ) Children ' s age health is bad , middle and old age SES is lower , the incidence of daily activity ability and depressive symptoms is low , the incidence of self - assessment is worse , the daily activity ability is damaged , depression symptom is high , cognitive function is low . Therefore , the difference between social and economic status helps to reduce health inequality .

The conclusion is as follows : ( 1 ) Pay attention to the long - term impact of the social and economic status of childhood on the whole life course , and reduce the children ' s life as the best time to reduce the health difference in the course of life .

Innovation and deficiency

Based on the theory of life history , the relationship between social and economic status of childhood and the health status of middle - aged and old people is discussed comprehensively on the basis of life history theory .

It is difficult to determine the direction of causality . ( 2 ) For individuals with low socio - economic status , it is difficult to determine the direction of causality . ( 2 ) For individuals with low socioeconomic status , it may lead to some sample selection bias .
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R179;R592

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本文編號(hào)：2013417