Self-Assessed Health and Socioeconomic Inequalities in Serbia: Data from 2013 National Health Survey

摘要

Socioeconomic inequalities—impact on health Health inequities are differences in health status or health determinants between population groups, which are unjust because they reflect an unfair distribution of the underlying social determinants of health (Marmot, 2005 ; World Health Organization, 2013 ; Arcaya et al., 2015 ). This is a global phenomenon, seen in low, middle (Jakovljevic and Getzen, 2016 ) and high income countries (Ogura and Jakovljevic, 2014 ). The largest contribution to inequalities in health is attributable to socio-economic determinants of health, or the societal conditions in which people are born, grow up, live, work, and age, which in turn are determined by wider economic, social, and political conditions (Liu et al., 2002 ). Socialeconomic inequalities are defined as “differences in the prevalence or incidence of health problems between individual people of higher or lower socioeconomic status” (World Health Organization, 2013 ). Commission on Social Determinants of Health of the World Health Organization (WHO) has singled out 10 determinants of health important for injustice in health: social gradient, stress, early life, social exclusion, employment, unemployment, social support, addiction, food, and transport (World Health Organization, 2008 ). Socialeconomic inequalities are usually measured by income, education, and occupation (Mackenbach et al., 2008 ; World Health Organization, 2010 ). Strong associations between health and socioeconomic determinants have been documented in many studies (Mackenbach et al., 2008 ; Kaikkonen et al., 2009 ; Mackenbach, 2012 ). Considerable evidence suggests that lower socioeconomic status are associated with a poor self-perceived health, higher prevalence of chronic diseases (Radovanovi? et al., 2011 ; Lazic et al., 2012 ), and injuries, unhealthy behaviors such as smoking, inadequate diet, alcohol use (Jovanovic and Jakovljevic, 2011 ), and lack of physical exercise (De Looper and Lafortune, 2009 ; Dorjdagva et al., 2015 ). People of lower SES can expect to live less years in good health, have higher rates of mortality and die at younger ages (Mackenbach, 2012 ). Socioeconomic inequalities are measured by various indicators of health such as life expectancy (Jakovljevic et al., 2015c ), incidence of various diseases (Jakovljevic and Milovanovic, 2015 ), mortality, and self-assessment of health (Vukovi? et al., 2012 ). Self-assessment of health is one of the most commonly used health indicators recommended by WHO and European Union Commission (Jankovi? et al., 2012 ). Self-assessed health is a commonly used measure of health status that asks individuals to rate their general health on five-point Likert scale with with five possible answers: very good; good; fair; bad; or very bad. The measure provides a valid and reliable assessment of overall health status, and has been found to be predictive of future health outcomes when used in national population health surveys (Park et al., 2015 ; Jakovljevic et al., 2016c ). Also, it was found that the self-assessment of health is one of the important predictors of mortality, morbidity, functional limitations, and health care use in the population (Burstr?m and Fredlund, 2001 ; Müters et al., 2005 ). Comparative study of 22 European countries indicating that in almost all countries the prevalence of poorer self-assessments of health were significantly higher in groups of lower socioeconomic status (Mackenbach et al., 2008 ). People with lower level of education or income and unemployed persons are more likely to have poor self-assessed health (McFadden et al., 2008 ). Despite the global wealth (Jakovljevic, 2016 ) and application of the best evidence-based interventions, socioeconomic inequalities in health are important, and ongoing public health problem in all European countries (Jakovljevic et al., 2016a ) and a major challenge for the enactment and implementation of health policy (Jakovljevic, 2014 ). In Serbia, as in many countries in transition, socioeconomic inequalities in health have not been sufficiently studied, neither they receive due attention in public health policies (Jakovljevic et al., 2016b ). The data report methods Public data set description—serbian 2013 national health survey Data belonging to the 2013 National Health Survey for Serbia were observed (Results of the National Health Survey of the Republic of Serbia, 2013 ). These data were acquired using a cross-sectional studies on a representative probability sample of adult citizens aged 15 years or more (excluding Kosovo). The survey was conducted in accordance with the methodology and instruments of the European Health Interview Survey wave 2 (EHIS-wave 2). It was implemented by the Ministry of Health of the Republic of Serbia. The sample consisted of all households listed by all enumeration areas of Census 2013. The mechanism used to generate a random sample of households and respondents is a combination of two sampling techniq