Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies.
Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies.
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DOI：
10.1136/oemed-2012-101331
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发表时间：
2013-09
影响因子：
4.9
通讯作者：
Siegrist J
中科院分区：
文献类型：
--
作者：
Hoven H;Siegrist J
健康方面的社会不平等在现代社会中仍然存在。不利的工作和就业条件对其解释的贡献分析了两种方法，调解和调节。然而，在各自的研究中，每种方法的相对重要性仍不清楚。我们通过进行系统的文献回顾来研究这个问题。我们纳入了1980年1月至2012年10月期间发表的所有基于前瞻性观察性研究的原始论文，这些论文通过使用主要数据库并遵循已建立的质量标准，符合我们的搜索标准。质量评价后纳入26份报告。17项研究检验中介假设，9项研究检验适度假设。在多变量模型中引入工作特征后，在大多数分析中，根据社会经济地位（SEP）降低健康的OR或HR的中介假设得到适度支持。在一些研究中发现了支持适度假设的证据，表明在低SEP人群中，不利工作对健康的影响更大。尽管一些人支持这两种假设，但未来的研究应致力于减少定义和测量核心变量的异质性，并应用先进的统计分析。政策建议将受益于各自研究证据的更高程度的一致性。
Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.
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