Mediation Role of Social Relationships in the Association Between Socioeconomic Position and Health/0ral Health

卫生方面的社会不平等被普遍认为是一个主要的公共卫生问题(世卫组织，2008)。对健康不平等的解释包括物质、行为和心理社会途径。虽然物质和行为途径已经被广泛研究，但很少有研究探索社会关系对健康中的社会梯度的贡献。“社会关系”一词是一个总括的术语，包括社会网络和社会支持的概念。社会关系对健康和福祉的重要性是公认的(Holt-Lunstad等人，2010年；Berkman和Krishna，2014年)，而且有证据表明，获得社会网络和社会支持受到社会经济地位的影响(House等人，1988年；Taylor和Seeman，1999年)。人们发现，终生面临社会经济劣势的人在退休后变得不那么活跃，比他们更富裕的同龄人更早面临限制性疾病(Blane等人，2007年)。鉴于有证据表明，社会参与和社会联系是健康的重要决定因素，必须了解社会关系是否也造成健康和健康老龄化方面的社会不平等--这一领域仍不太为人所知。现有的考察社会关系在健康不平等中的中介作用的研究数量有限，主要关注死亡率和心血管疾病，然而结果相互矛盾(Marmot等人，1998；von Dm Kneebeck，2005；Stringhini等人，2012；Wang等人，2015；McCrory等人，2016；Aartsen等人，2017；Gorman和Sivan anesan，2017)。目的/目的本研究旨在考察社会关系在社会经济地位与健康之间的关系中的中介作用。将讨论以下目标：1.评估健康结果的社会梯度2.评估社会关系是否与健康方面的社会经济不平等有关3.评估结构性和功能性社会关系在多大程度上解释了健康中的社会经济梯度。假设社会关系在社会经济地位和健康之间的联系中起中介作用。方法：我建议使用英国英语老龄化纵向研究(ELSA)的数据，来检验社会关系的动态及其对老年人健康不平等的影响。将考虑以下健康结果：自我评估的健康、自我评估的口腔健康和困难、身体功能和认知功能。ELSA是一个丰富的数据集，其中包含社会经济地位(教育、收入、财富)和社会关系(社会网络/凝聚力、社会支持、孤独感)的衡量标准。将使用回归模型和结构方程模型对假设的路径进行检验。拟议项目的结果可以为旨在通过促进积极参与和社会凝聚力来减少社会不平等的政策干预提供参考。

IntroductionSocial inequalities in health are universally recognised as a major public health problem (WHO, 2008). Explanations for health inequalities include material, behavioural and psychosocial pathways. Whilst material and behavioural pathways have been studied extensively, few studies have explored the contribution of social relationships to social gradients in health. The term 'social relationships' is an umbrella term including concepts of social networks and social support. The importance of social relationships for health and well-being is well established (Holt-Lunstad et al., 2010; Berkman and Krishna 2014), and there is evidence that access to social networks and social support is influenced by socioeconomic position (House et al., 1988; Taylor and Seeman, 1999). Individuals who face socioeconomic disadvantage throughout life have been found to become less socially active after retirement to face limiting illnesses earlier than their more affluent peers (Blane et al., 2007). Given the evidence that social engagement and social connectedness are important determinants of health, it would be imperative to understand whether social relationships also contribute to social inequalities in health and healthy ageing - an area that remains less well understood. The limited number of existing studies that examine the mediating role of social relationships on health inequalities have mainly looked at mortality and cardiovascular disease, however results have been contradictory (Marmot et al, 1998; von dem Knesebeck, 2005; Stringhini et al., 2012; Wang et al., 2015; McCrory et al., 2016; Aartsen et al, 2017; Gorman and Sivaganesan, 2017). Aims/ObjectivesThe proposed research aims to examine the mediating role of social relationships on the association between socioeconomic position and health. The following objectives will be addressed:1. To assess the social gradients in health outcomes 2. To assess whether social relationships are linked to socioeconomic inequalities in health3. To assess how much of the socioeconomic gradient in health is explained by structural and functional social relationshipsHypothesisIt is hypothesised that social relationships mediate the association between socioeconomic position and health. Methodology: I propose to use data from the UK English Longitudinal Study of Ageing (ELSA), to examine the dynamics of social relationships and their influence on health inequalities across older age. The following health outcomes will be considered: self-rated health, self-rated oral health and difficulties, physical function and cognitive function. ELSA is a rich dataset containing measures on socioeconomic position (education, income, wealth) and social relationships (social networks/cohesion, social support, loneliness). The hypothesised pathways will be tested using regression models and structural equation modelling.The findings of proposed project could inform policy interventions aimed at reducing social inequalities in health through promotion of active participation and social cohesion.