İyi sağlık algısına etki eden faktörlerin yaşam seyri yaklaşımı ile incelenmesi

Year 2023, , 71 - 86, 15.04.2023

Ferhan Saniye Palaz

https://doi.org/10.20518/tjph.1106798

Abstract

Amaç: Çocukluktaki iyi sağlık algısının erişkinlik dönemi dahil sürdürülmesine etki eden dolaylı ve dolaysız risk faktörlerini incelemektir. Yaşam seyri epidemiyolojisi teorik arka plan sağlamıştır. Buna göre sağlık, doğumla başlayıp çocukluk ve yetişkinliğin tümü boyunca tecrübe edilen sosyal ve biyolojik süreçlerden bir bütün olarak etkilenmektedir.

Yöntem: Nicel veri kaynağı olarak Avrupa Sağlık, Yaşlanma ve Emeklilik Araştırması (Survey of Health, Ageing and Retirement in Europe, SHARE) kullanılmıştır (n=15128). Retrospektif veri sayesinde: 1) 0-15 yaş dönemi için iyi olarak algılanan sağlığın 50+ erişkinlik döneminde algılanan sağlığa kadar nasıl dönüştüğünün (iyi kalma ya da kötüye dönme) incelenmesi, 2) Sağlığa etki etmesi beklenen risk faktörlerinin güncel durumla sınırlı olmadan yaşam seyrinin tümü boyunca (yaşamın herhangi bir döneminde sigara kullanmış olma gibi) değerlendirilmesi mümkün olmuştur. Tanımlayıcı analizlerin ardından hiyerarşik ikili lojistik regresyon analizi yürütülmüştür. Çoklu ortak doğrusallık varsayımı ihlal edilmemiştir. Hosmer ve Lemeshow uyum iyiliği testi, modeli desteklemektedir.

Bulgular: Post-sosyalist refah modeline kıyasla diğer üç refah modelinde (sosyal-demokrat, muhafazakâr-korporatist ve Akdeniz) yaşayan kişilerin 0-15 yaş iyi sağlık algısını 50+ dönem dahil sürdürmesi 2 kat fazladır. Düşük eğitim seviyesinin, hayatının herhangi bir döneminde ekonomik zorluk yaşamış olmanın, olumsuz çalışma koşullarının, fiziksel hareketsizlik ile preobez/obez olmanın ve göçmen olmanın iyi sağlık algısının sürdürülmesini olumsuz etkilediği görülmüştür. Sigara kullanma ve cinsiyet ise istatistiksel olarak anlamsız etkenler olmuştur.

Sonuç: Çocukluktaki iyi sağlık algısının yaşam seyri boyunca sürdürülmesi bireysel tercihler ve yaşam tarzı ile ilgili olduğu gibi, sosyal faktörlerden de etkilenmektedir. Nüfusun tümü eşit şartlarda yaşamadığı için iyi sağlığın sürdürülmesi, dezavantajlı gruplar için daha zordur

Keywords

Yaşam Seyri Yaklaşımı, Sosyal Epidemiyoloji, Retrospektif Veri, Nicel Araştırma, Survey Of Health, Ageing And Retirement In Europe

Using the life-course approach to analyse factors affecting good self-rated health

Abstract

Objective: The purpose of this study is to examine the direct and indirect factors affecting good self-rated health over the life-course in thirteen European countries. According to life-course epidemiology, health is affected by social and biological processes from birth to later years.

Methods: Survey of Health, Ageing and Retirement in Europe (SHARE) is used (n=15128). Retrospective data provided two basis for this study: 1) examine how good self-rated health of 0-15 early life changed until 50+ late life (maintenance good health or not), 2) determine the risk factors expected to affect health by using not only current but also earlier phases of life (such as smoking at any given point of life). For this end, Hierarchical binary logistic regression models were used. Multicollinearity was checked using VIFs and goodness of fit by Hosmer and Lemeshow test.

Results: It was found that living in social-democrat, conservative-corporatist and Mediterranean welfare regimes positively affects the maintenance good self-rated health from 0-15 (early life) to 50+ (late life) as compared to post-socialist welfare regime. Additionally it was observed lower levels of education, experience of financial hardship at any given point of life, negative work conditions (high physical and psycho-social demand, low reward and control), physical inactivity, pre-obesity/obesity, and migrant background negatively affect remaining in good health. Gender and smoking at any given point of life were statistically insignificant.

Conclusion: Maintaining good self-rated health over the life-course is harder for disadvantaged groups and is affected by both individual lifestyle and social factors.

Keywords

Life course perspective, social epidemiology, retrospective study, Survey of Health, Ageing and Retirement in Europe

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