What causes health inequality? A systematic review on the relative importance of social causation and health selection
What causes health inequality? A systematic review on the relative importance of social causation and health selection
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DOI：
10.1093/eurpub/ckv111
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发表时间：
2015-12-01
影响因子：
4.4
通讯作者：
Hoffmann, Rasmus
中科院分区：
文献类型：
--
作者：
Kroeger, Hannes;Pakpahan, Eduwin;Hoffmann, Rasmus
背景：健康的社会梯度是公共卫生研究中最可靠的发现之一。试图解释这种梯度的两个相互竞争的假说是社会因果关系假说和健康选择假说。目前还没有综合检验这两种假设的研究结果。方法：采用遵循PRISMA规则的7个数据库，对1994年至2013年间涉及健康选择和社会因果假设的文献进行了系统回顾。结果：检索策略得到2952项研究，其中34项纳入综述。综合这些研究表明，对这两种假设都没有普遍的偏好（12项关于社会因果关系的研究，10项关于健康选择的研究）。然而，叙事综合和元回归结果都表明，使用与劳动力市场密切相关的社会经济地位（SES）指标的研究发现健康选择和社会因果关系同样得到支持，而教育和收入等社会经济地位指标的结果则有利于社会因果关系假设。统计建模的高标准与对健康选择的更多支持有关。结论：审查强调了这样一个事实，即健康不平等背后的因果机制取决于所分析的维度是否密切反映了劳动力市场的成功。此外，进一步的研究应努力改进因果关系的统计模型，因为这可能会影响有关健康选择和社会因果关系相对重要性的结论。
Background: The social gradient in health is one of the most reliable findings in public health research. The two competing hypotheses that try to explain this gradient are known as the social causation and the health selection hypothesis. There is currently no synthesis of the results of studies that test both hypotheses. Methods: We provide a systematic review of the literature that has addressed both the health selection and social causation hypotheses between 1994 and 2013 using seven databases following PRISMA rules. Results: The search strategy resulted in 2952 studies, of which, we included 34 in the review. The synthesis of these studies suggests that there is no general preference for either of the hypotheses (12 studies for social causation, 10 for health selection). However, both a narrative synthesis as well as meta-regression results show that studies using indicators for socio-economic status (SES) that are closely related to the labor market find equal support for health selection and social causation, whereas indicators of SES like education and income yield results that are in favor of the social causation hypothesis. High standards in statistical modeling were associated with more support for health selection. Conclusions: The review highlights the fact that the causal mechanisms behind health inequalities are dependent on whether or not the dimension being analyzed closely reflects labor market success. Additionally, further research should strive to improve the statistical modeling of causality, as this might influence the conclusions drawn regarding the relative importance of health selection and social causation.