Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe
Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe
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DOI：
10.1136/jech.2009.102517
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发表时间：
2011-12-01
影响因子：
6.3
通讯作者：
Niedhammer, I.
中科院分区：
文献类型：
--
作者：
Aldabe, B.;Anderson, R.;Niedhammer, I.
目的分析社会经济地位（SES）与自我报告健康之间的关系，并检查欧洲各种物质、职业和社会心理因素对健康社会不平等的影响。方法本研究基于2003年欧洲生活质量调查（EQLS）的数据。样本包括来自欧洲28个国家的6038和6383名在职男女（回应率：30.3-91.2%）。每组潜在的物质、职业和社会心理媒介包括8到11个变量。采用多水平logistic回归分析进行统计分析。结果在自我报告的健康状况方面观察到显著的社会差异，体力劳动者更有可能健康状况不佳（男性OR=1.89, 95% CI 1.46至2.46，女性OR=2.18, 95% CI 1.71至2.77）。几乎所有潜在的中介因素都有很强的社会梯度，而且几乎所有因素都与自我报告的健康状况有显著的关联。在对物质、职业和社会心理因素进行调整后，健康方面的社会差异大大缩小，其中物质因素发挥了主要作用。物质匮乏、社会排斥、经济问题和工作奖励是减少这些差异的四大因素。考虑到所有中介因素，对男性和女性健康方面的社会差异的解释为78% -100%。结论社会经济地位与健康状况不佳之间的关系可能与职业群体在物质、职业和社会心理等方面的差异分布有关。针对不同方面的干预措施可能导致减少健康方面的社会不平等。
Objectives To analyse the associations between socioeconomic status (SES), measured using occupation, and self-reported health, and to examine the contribution of various material, occupational and psychosocial factors to social inequalities in health in Europe.Methods This study was based on data from the European Quality of Life Survey (EQLS) carried out in 2003. The total sample consisted of 6038 and 6383 working men and women in 28 countries in Europe (response rates: 30.3-91.2%). Each set of potential material, occupational and psychosocial mediators included between eight and 11 variables. Statistical analysis was performed using multilevel logistic regression analysis.Results Significant social differences were observed for self-reported health, manual workers being more likely to be in poor health (OR=1.89, 95% CI 1.46 to 2.46 for men, OR=2.18, 95% CI 1.71 to 2.77 for women). Strong social gradients were found for almost all potential mediating factors, and almost all displayed significant associations with self-reported health. Social differences in health were substantially reduced after adjustment for material, occupational and psychosocial factors, with material factors playing a major role. The four strongest contributions to reducing these differences were found for material deprivation, social exclusion, financial problems and job reward. Taking all mediators into account led to an explanation of the social differences in health by 78-100% for men and women.Conclusion The association between SES and poor health may be attributed to differential distributions of several dimensions of material, occupational and psychosocial conditions across occupational groups. Interventions targeting different dimensions might result in a reduction in social inequalities in health.