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研究生:邱雅芳
研究生(外文):Chiu, Ya-Fang
論文名稱:台灣縣市層次因子與中老年人健康關係之多層次模型分析
論文名稱(外文):County-level Effect on Elderly Health in Taiwan
指導教授:李妙純李妙純引用關係
指導教授(外文):Lee, Miaw-Chwen
口試委員:鄭文輝陳孝平
口試日期:2011-07-29
學位類別:碩士
校院名稱:國立中正大學
系所名稱:社會福利學系暨研究所
學門:社會服務學門
學類:社會工作學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:81
中文關鍵詞:地區層次因子中老年人健康多層次模型分析
外文關鍵詞:area effectmulti-level analysiselderly health
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隨著平均餘命的延長,老年人的健康與生活品質成為社會所關心的議題,但健康結果不僅只是個人因素所造成的,外在社會環境亦是重要的決定因素。本文使用2007年「中老年身心社會生活狀況長期追蹤調查」資料,研究54歲以上受訪者,運用多層次模型分析地區層次因子對於中老年人「憂鬱與否」及「自評健康好壞」的影響。過去文獻認為因為不同的地區脈絡效果,以及地區組成效果不相同,造成生活在不同地區的個人健康狀態的差異。因此本研究以此為概念,選取失業率、家戶全年經常性收入、以及服務業人口佔就業人口比例等,作為地區組成效果變項。另將地區脈絡效果分為集體社會功能與基礎物質建設兩類,以縣市收入吉尼係數、福利支出佔歲出比例作為集體社會功能的代表變項;縣市內是否有醫學中心、每萬人平均診所數、每萬人宗教團體數作為基礎物質建設的代理變項。研究結果顯示,地區層次變項在控制個人性別、年齡、教育以及婚姻狀況後,地區因子對於個人健康結果的確有影響:縣市家戶平均收入較高、每萬人宗教寺廟教堂數較高的地區,憂鬱的風險較低,且自評健康的機率較高。疾病預防策略上,將政策目標焦點放在減少整體民眾的風險,會比僅將資源投注在高風險個人更來得有效益,因對於高風險個人的預防策略,所投注的資源僅對於該對象有所作用,但若將目標放在減低民眾群體的健康風險,所投資的建設即能普及至一般大眾,不限於特定的群體或個人。因此政策應更重視台灣區域內的所得分配以及不同地區的建設,以提高整體老年人的健康狀態。
Objective: This study investigated individual and area effects on the probability of depression and self-rated health for the elderly in Taiwan.

Data and methods: Data for the study came from the 2007 Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, which is consist of representative sample of 4,534 people aged 54 and older. This study applied multi-level regressions to control for intra-area correlation. The area effect was divided into compositional effects and contextual effects. On one hand, the compositional effects were measured by unemployment rate, annual average household income, and ratio of service-industry manpower to total employed population among areas. On the other hand, The contextual effects were measured by income Gini coefficient, annual welfare spending, whether there is any medical center in an area, doctor clinic density and church or temple density.

Results: 18.13% of elderly are reported with depression, while 26.80% with poor health. In the multi-level model, individual characteristics and area effects are both associated with depression and self-rated health. There are 2.78% of variance for depression and 4.26% of variance for self-rated health can be explained by the county-level variation. We also found even after adjusting individual characteristics, county-level variables are still influential to individual health status.

Conclusions: Although the influence of individual-level characteristics on health appears to be greater than that of area effect, the finding of this study, in accordance to studies conducted in Western countries, suggests that area effects might be important determinants of both mental and physical health for the elderly.

摘要 I
英文摘要 II
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 5
第二章 文獻探討 6
第一節 地區差異的概念 6
第二節 地區健康差異之相關實證研究 16
第三節 解釋地區健康差異的論點 25
第三章 研究方法 30
第一節 實證研究架構 30
第二節 研究假說 31
第三節 資料來源 32
第四節 研究變項 33
第五節 分析模型 37
第四章 研究結果 40
第一節 描述性統計 40
第二節 雙變項分析 43
第三節 多層次分析模型 48
第五章 討論 56
第一節 地區變項之選擇 56
第二節 地區因子的效果 58
第六章 結論與建議 69
第一節 結論 69
第二節 政策意涵 71
第三節 研究限制與未來發展 73
參考文獻 74
附錄一:憂鬱量表(CES-D) 80
附錄二:2006年縣市層次變項相關係數矩陣 81


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