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Educational differences in age -related patterns of disease: An empirical test of cumulative disadvantage theory.

机译：与年龄相关的疾病模式的教育差异：累积不利理论的实证检验。

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摘要

This dissertation investigates the relationship between education and health and extends our understanding of how this relationship varies across age. Some evidence suggests that educational differences in health increase over the life course according to a cumulative disadvantage perspective. Other studies find that health inequalities diminish in late adulthood and support the age-as-leveler argument. I argue that both hypotheses are valid and that existing research remains fragmented because it inadequately distinguishes individual health-decline from aggregate changes occurring in the population. This research tests whether both arguments support the same process from different units of analysis. In a departure from previous research that focuses almost exclusively on population-level indicators, I examine measures of disease prevalence, incidence, and survival to differentiate individual health-decline from aggregate changes in health. A secondary objective of the research explores how several behavioral, social, and economic disadvantages affect the onset and duration of disease over the life course. Four waves of the National Health and Nutrition Examination Survey-I (NHANES I) Epidemiologic Follow-up Study (NHEFS) are used for analysis. Results from age-specific prevalence rates and pooled logistic regression models support the leveling hypothesis by showing educational differences in disease prevalence are largest at mid-life and decline at older ages. Results from discrete-time and semi-parametric hazard models support the cumulative disadvantage hypothesis by showing that education is positively related to the age of onset of disease and/or the duration of survival after onset. The results are generally consistent across cohorts with somewhat stronger effects in the two youngest cohorts. I conclude from the findings that cumulative disadvantage operates at the individual level by increasing age-specific rates of illness and mortality; leveling occurs at the population level as a reflection of the inequalities in health decline and mortality selection. The implications of these findings are discussed.
机译：本文研究了教育与健康之间的关系，并扩展了我们对这种关系如何随年龄变化的理解。一些证据表明，根据累积不利因素的观点，在整个生命过程中，健康方面的教育差异会增加。其他研究发现，健康不平等现象在成年后期有所减少，并支持了年龄平等的观点。我认为这两种假设都是有效的，并且现有的研究仍然是零散的，因为它不足以将个人健康下降与总体发生的变化区分开来。这项研究测试了两个论点是否支持来自不同分析单位的相同过程。与以前的研究几乎完全专注于人口水平的指标不同，我研究了疾病患病率，发病率和生存率的测量方法，以区分个体健康下降与总体健康变化。该研究的第二个目标是探索在生活过程中，几种行为，社会和经济上的不利因素如何影响疾病的发作和持续时间。进行了四次国家卫生和营养检查-I（NHANES I）流行病学随访研究（NHEFS）。特定年龄段的患病率和汇总的逻辑回归模型的结果通过显示疾病患病率的教育差异在中年时最大，而在老年时下降而证明了水平假设。离散时间和半参数风险模型的结果通过证明教育与疾病发作的年龄和/或发病后的生存时间呈正相关关系，支持了累积不利假设。结果总体上在所有队列中均一致，而在两个最年轻的队列中效果更强。我从调查结果中得出结论，累积性不利条件通过提高特定年龄段的疾病和死亡率而在个人层面发挥作用。人口水平的提高反映了健康下降和死亡率选择方面的不平等现象。讨论了这些发现的含义。

著录项

  • 作者

    Dupre, Matthew E.;

  • 作者单位

    Duke University.;

  • 授予单位 Duke University.;
  • 学科 Sociology Theory and Methods.;Health Sciences Public Health.;Sociology Demography.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 166 p.
  • 总页数 166
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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