Pathways between socioeconomic determinants of health

被引:320
作者
Lahelma, E
Martikainen, P
Laaksonen, M
Aittomäki, A
机构
[1] Univ Helsinki, Dept Publ Hlth, FIN-00014 Helsinki, Finland
[2] Univ Helsinki, Dept Sociol, Populat Res Unit, FIN-00014 Helsinki, Finland
[3] UCL, Sch Med, Dept Epidemiol & Publ Hlth, Int Ctr Hlth & Soc, London W1N 8AA, England
关键词
D O I
10.1136/jech.2003.011148
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Study objective: Many previous studies on socioeconomic inequalities in health have neglected the causal interdependencies between different socioeconomic indicators. This study examines the pathways between three socioeconomic determinants of ill health. Design, setting, and participants: Cross sectional survey data from the Helsinki health study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55, and 60 years received a mailed questionnaire. Altogether 6243 employees responded (80% women, response rate 68%). Socioeconomic indicators were education, occupational class, and household income. Health indicators were limiting longstanding illness and self rated health. Inequality indices were calculated based on logistic regression analysis. Main results: Each socioeconomic indicator showed a clear gradient with health. Among women half of inequalities in limiting longstanding illness by education were mediated through occupational class and household income. Inequalities by occupational class were largely explained by education. A small part of inequalities for income were explained by education and occupational class. For self rated health the pathways were broadly similar. Among men most of the inequalities in limiting longstanding illness by education were mediated through occupational class and income. Part of occupational class inequalities were explained by education. Two thirds of inequalities by income were explained by education and occupational class. Conclusions: Parts of the effects of each socioeconomic indicator on health are either explained by or mediated through other socioeconomic indicators. Analyses of the predictive power of socioeconomic indicators on health run the risk of being fruitless, if interrelations between various indicators are neglected.
引用
收藏
页码:327 / 332
页数:6
相关论文
共 47 条
[1]   INEQUALITIES IN WOMENS AND MENS ILL-HEALTH - BRITAIN AND FINLAND COMPARED [J].
ARBER, S ;
LAHELMA, E .
SOCIAL SCIENCE & MEDICINE, 1993, 37 (08) :1055-1068
[2]   CLASS, PAID EMPLOYMENT AND FAMILY ROLES - MAKING SENSE OF STRUCTURAL DISADVANTAGE, GENDER AND HEALTH-STATUS [J].
ARBER, S .
SOCIAL SCIENCE & MEDICINE, 1991, 32 (04) :425-436
[3]  
BARTLEY M, 1992, SOCIOL HEALTH ILL, V14, P313
[4]   Understanding the relationship between income and health: How much can be gleaned from cross-sectional data? [J].
Benzeval, M ;
Judge, K ;
Shouls, S .
SOCIAL POLICY & ADMINISTRATION, 2001, 35 (04) :376-396
[5]  
BLAXTER M, HLTH INEQUALITIES EU, P199
[6]   Health selection in the Whitehall II study, UK [J].
Chandola, T ;
Bartley, M ;
Sacker, A ;
Jenkinson, C ;
Marmot, M .
SOCIAL SCIENCE & MEDICINE, 2003, 56 (10) :2059-2072
[7]   SOCIAL INEQUALITIES IN ILL-HEALTH - THE SIGNIFICANCE OF OCCUPATIONAL-STATUS, EDUCATION AND INCOME - RESULTS FROM A NORWEGIAN SURVEY [J].
DAHL, E .
SOCIOLOGY OF HEALTH & ILLNESS, 1994, 16 (05) :644-667
[8]  
Der G, 1999, EUR J PUBLIC HEALTH, V9, P271
[9]   Income and health: what is the nature of the relationship? [J].
Ecob, R ;
Smith, GD .
SOCIAL SCIENCE & MEDICINE, 1999, 48 (05) :693-705
[10]  
Fox AJ, 1989, HLTH INEQUALITIES EU, P142