The Effect of Educational Differentials on Mortality of the Elderly in Taiwan

台灣地區老人教育程度差異對死亡率影響探討

10.6288/TJPH2011-30-01-07

林正祥(Cheng-Hsiang Lin)；鄭維芬(Wei-Fen Cheng)

教育 ； 老人保健與生活問題調查 ； 存活狀況 ； 脆弱Cox比例風險模式 ； education ； survey of health and living status of the elderly ； survival status ； Coxfrailty proportional hazard model

台灣公共衛生雜誌

30卷1期（2011 / 02 / 15）

58 - 71

英文

目標：探討教育程度差異對台灣老人死亡率的影響。方法：採用前衛生署家庭計畫研究所起始於1989年5次「台灣地區老人保健與生活問題調查」實際訪察4,049個案為研究對象，排除與教育無關的死亡案例，蒐集其與死亡率相關之變數，並考慮可能存在模式中未能辨識的干擾因子，以脆弱Cox比例風險存活模式探討教育程度差異與死亡率間的關係。本研究以外在因子（教育及相關人口變數）等變數建構模式一，其他三個模式則分別為模式一加上一個、二個或三個中介因子（健康狀況、健康行為及社會參與），故模式四則為包含外在因子及三個中介因子，藉此探討教育對死亡率的間接影響。結果：在未考慮三個中介因子之情形下，教育程度較高者死亡風險較低，受教育每增加一年，死亡風險下降13.7%。另一方面，在模型中加入和健康因子相關的變數會使教育對死亡率的影響不顯著，惟每增加一年教育，死亡風險下降6.1%。結論：教育對死亡率之影響係其藉由健康狀況、健康行為及社會參與等相關變數，其中又以健康狀況因子之影響為最。另外，不論是否考慮健康相關因子，本研究中人口相關變數均與老人死亡率有密切關係。

Objectives: To study the effect of educational differentials on mortality of the elderly in Taiwan. Methods: Our research uses five waves of surveys of health and living status of the elderly conducted from 1989-2003 in Taiwan to investigate the trend of effect of education on elderly mortality. Exogenous factors (education and other demographic characteristics) were included in Model 1. The other 3 models are with each adding one, two or three mediating factors (health status, health behaviors and social relationships) from Model 1. Both exogenous and mediating factors were included in Model 4. The 4 models present information of the decomposition of the effect of education on the mortality of older Taiwanese from 1989 to 2003. This study exclude those death cases due to accident which is not related to education and adopt Cox-frailty proportional hazard model which accounts for heterogeneity caused by some other unidentified factors related to the effect of social dynamic on old-age mortality. Results: Without considering the three mediate factors, there is a 13.7% reduction on mortality pre year education increased. On the other hand, it turns out the effect of education on the mortality is insignificant when the three mediate factors are included in the model. The hazard ratio reduced 6.1% on mortality with a 1-year increase in education. Conclusions: The effect of education on the mortality of the elderly is by means of the 3 mediating factors, particularly health status. Besides, no matter health related factors are in the model or not, demographics characteristics show strong relationship with the mortality of the elderly.

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