Education and occupational social class: which is the more important indicator of mortality risk?
Education and occupational social class: which is the more important indicator of mortality risk?
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教育和职业社会阶层：哪个是死亡风险更重要的指标？
DOI：
10.1136/jech.52.3.153
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发表时间：
1998
影响因子：
6.3
通讯作者：
V. Hawthorne
中科院分区：
文献类型：
--
作者：
G. D. Smith;C. Hart;D. Hole;P. MacKinnon;C. Gillis;G. Watt;D. Blane;V. Hawthorne
研究目标：在英国，死亡率社会经济差异的研究通常依赖于职业社会阶层作为社会经济地位的指标，而在美国，基于教育的衡量标准已被广泛使用。这两项措施各有特点；例如，社会阶层可能在整个成年生活中发生变化，而教育在成年早期后不太可能改变。因此，可以对所观察到的死亡率差异给出不同的解释。本分析的目的是展示死亡率差异的概况以及这些差异背后的因素，这些因素与两种社会经济指标相关。设计：前瞻性观察研究。地点：苏格兰西部 27 个工作地点。参与者：5749 名 35-64 岁的男性在 1970 年至 1973 年间完成了问卷调查并接受了检查。结果：在基线时，无论是否使用教育或社会阶层衡量标准，社会经济地位与血压、身高、肺功能和吸烟行为之间都存在类似的梯度。体力社会阶层和提前终止全日制教育与血压升高、身高矮小、肺功能较差和吸烟率较高有关。在教育阶层内，吸烟与社会阶层之间的分级关联仍然很强，而在社会阶层群体内，教育与吸烟之间的关系减弱。经过 21 年的追踪，其中 1639 人死亡。所有原因和三大主要死因（心血管疾病、恶性疾病和其他原因）的死亡率与社会阶层和教育程度表现出类似的关联。对于所有死因群体来说，从事体力社会活动的男性和早年终止全日制教育的男性死亡率较高。心血管疾病是与教育程度最密切相关的死亡原因，而非心血管非癌症类别是与成年社会阶层最密切相关的死亡原因。在教育阶层内，社会阶层与全因死亡率之间的分级关联仍然很强且显着，而在社会阶层内，教育与死亡率之间的关系不太明确。结论：作为社会经济地位的单一指标，成年期职业社会阶层比教育更能区分死亡率和吸烟行为的社会经济差异。这与将文化资源而非物质资源视为健康社会经济差异的关键决定因素的解释相悖。与其他死因相比，教育与心血管原因死亡的关联性更强，这可能反映了教育作为生命早期社会经济状况指标的功能，这似乎对心血管疾病的风险具有特殊的影响。
STUDY OBJECTIVES: In the UK, studies of socioeconomic differentials in mortality have generally relied upon occupational social class as the index of socioeconomic position, while in the US, measures based upon education have been widely used. These two measures have different characteristics; for example, social class can change throughout adult life, while education is unlikely to alter after early adulthood. Therefore different interpretations can be given to the mortality differentials that are seen. The objective of this analysis is to demonstrate the profile of mortality differentials, and the factors underlying these differentials, which are associated with the two socioeconomic measures. DESIGN: Prospective observational study. SETTING: 27 work places in the west of Scotland. PARTICIPANTS: 5749 men aged 35-64 who completed questionnaires and were examined between 1970 and 1973. FINDINGS: At baseline, similar gradients between socioeconomic position and blood pressure, height, lung function, and smoking behaviour were seen, regardless of whether the education or social class measure was used. Manual social class and early termination of full time education were associated with higher blood pressure, shorter height, poorer lung function, and a higher prevalence of smoking. Within education strata, the graded association between smoking and social class remains strong, whereas within social class groups the relation between education and smoking is attenuated. Over 21 years of follow up, 1639 of the men died. Mortality from all causes and from three broad cause of death groups (cardiovascular disease, malignant disease, and other causes) showed similar associations with social class and education. For all cause of death groups, men in manual social classes and men who terminated full time education at an early age had higher death rates. Cardiovascular disease was the cause of death group most strongly associated with education, while the non-cardiovascular non-cancer category was the cause of death group most strongly associated with adulthood social class. The graded association between social class and all cause mortality remains strong and significant within education strata, whereas within social class strata the relation between education and mortality is less clear. CONCLUSIONS: As a single indicator of socioeconomic position occupational social class in adulthood is a better discriminator of socioeconomic differentials in mortality and smoking behaviour than is education. This argues against interpretations that see cultural--rather than material--resources as being the key determinants of socioeconomic differentials in health. The stronger association of education with death from cardiovascular causes than with other causes of death may reflect the function of education as an index of socioeconomic circumstances in early life, which appear to have a particular influence on the risk of cardiovascular disease.
影响因子：
5.4
作者：
Elo, IT;Preston, SH
通讯作者：
Preston, SH
影响因子：
12.7
作者：
WINKLEBY, MA;JATULIS, DE;FORTMANN, SP
通讯作者：
FORTMANN, SP