标题：Socioeconomic Position and Self-Rated Health: The Contribution of Childhood Socioeconomic Circumstances, Adult Socioeconomic Status, and Material Resources
摘要：Objectives . We examined socioeconomic inequalities in self-rated health by analyzing indicators of childhood socioeconomic circumstances, adult socioeconomic position, and current material resources. Methods . We collected data on middle-aged adults employed by the City of Helsinki (n=8970; 67% response rate). Associations between 7 socioeconomic indicators and health self-ratings of less than “good” were examined with sequential logistic regression models. Results . After adjustment for age, each socioeconomic indicator was inversely associated with self-rated health. Childhood economic difficulties, but not parental education, were associated with health independently of all other socioeconomic indicators. The associations of respondents’ own education and occupational class with health remained when adjusted for other socioeconomic indicators. Home ownership and economic difficulties, but not household income, were the material indicators associated with health after full adjustment. Conclusions . Own education and occupational class showed consistent associations with health, but the association with income disappeared after adjustment for other socioeconomic indicators. The effect of parental education on health was mediated by the respondent’s own education. Both childhood and adulthood economic difficulties showed clear associations with health and with conventional socioeconomic indicators. Socioeconomic status or position (SEP) is a powerful predictor of premature morbidity and mortality. An association between SEP and health has been found across different industrial societies for several major diseases and causes of death. 1 , 2 However, the exact ways in which SEP is associated with health are still not fully understood. A key challenge to a deeper understanding of this association is the fact that SEP is a multidimensional theoretical construct that covers a variety of social and financial circumstances. These circumstances can be measured using several different indicators. 3 , 4 Although all of these indicators reflect one’s position in the socioeconomic hierarchy, they also represent different dimensions of SEP, and each indicator only partially captures the full range of this broad summary concept. Therefore, any single socioeconomic indicator from 1 point of time is unlikely to provide a sufficient explanation for socioeconomic inequalities in health. Various mediating mechanisms have been suggested for the association between SEP and health. 5 , 6 These mechanisms may not be exactly the same for all socioeconomic indicators. 7 , 8 The conventional indicators of SEP include education, occupational class, and income. 3 , 4 Educational level and occupational class can be considered as indicators of one’s status and social standing. Educational level is a major factor in sorting people into positions with different tasks and rewards, and, like occupational class, it may reflect shared lifestyles and cultural values held by socioeconomic groups. Because educational level relates more directly to knowledge and skills than do other socioeconomic indicators, its role in health-related behaviors may be prominent, whereas occupational class may better reflect physical and psychosocial working conditions. Furthermore, educational level and occupational class influence people’s access to material resources. The key measure of material resources is income, but other indicators, ranging from immediate economic difficulties 9 to long-term cumulative wealth, 10 are often used. Material resources may influence health indirectly by imposing financial constraints on some healthy behaviors and, more directly, by affecting living conditions and other factors associated with financial and material disadvantage. 7 , 11 Furthermore, socioeconomic influences on adult health may go back to one’s childhood. 12 – 14 Not only are those born into higher SEPs more likely to end up in higher SEPs themselves, 15 but socioeconomic disadvantage in childhood may itself be associated with poorer health in later life, and this association appears to be partly independent of adult SEP. 16 – 18 Previous studies that have examined socioeconomic inequalities in health using multiple indicators of SEP have shown that the contributions of these indicators are partly independent of each other. 19 – 22 Furthermore, the prevalence of poor health is particularly high if several disadvantageous socioeconomic characteristics are present. 23 – 25 This empirical evidence thus supports the view that there is a need for approaches that comprehensively analyze socioeconomic influences on health. The purpose of this study was to examine socioeconomic inequalities in self-rated health among middle-aged women and men by several indicators, ranging from childhood socioeconomic status or circumstances to adult socioeconomic position and current material resources.
