摘要：Objectives . We examined whether the social gradient for measures of morbidity is comparable in English and French public employees and investigated risk factors that may explain this gradient. Methods . This longitudinal study of 2 occupational cohorts—5825 London civil servants and 6818 French office-based employees—used 2 health outcomes: long spells of sickness absence during a 4-year follow-up and self-reported health. Results . Strong social gradients in health were observed in both cohorts. Health behaviors showed different relations with socioeconomic position in the 2 samples. Psychosocial work characteristics showed strong gradients in both cohorts. Cohort-specific significant risk factors explained between 12% and 56% of the gradient in sickness absence and self-reported health. Conclusions . Our cross-cultural comparison suggests that some common susceptibility may underlie the social gradient in health and disease, which explains why inequalities occur in cultures with different patterns of morbidity and mortality. Numerous factors have been hypothesized to explain persistent findings of social inequalities in morbidity and mortality. 1 Explanations include household income, 2 differential health behaviors, 2, 3 early life environment, 4, 5 differences in access to medical care, 6, 7 and social relationships. 8, 9 More recently, the psychosocial work environment has been shown to play an important part in explaining health differentials, 10, 11 and neo–material interpretation (i.e., that inequalities result from differential accumulation of exposures and experiences that have their sources in the material world) have been hypothesized as another explanatory mechanism. 12 This study examined—in 2 cultures with many similarities but also many differences (i.e., England and France)—the social gradient in health and possible risk factors in order to assess the degree of consistency of explanatory mechanisms. Life expectancy for men is virtually the same in both countries (∼74 years), although for women, it is about 3 years longer in France (∼83 years). Social inequalities in mortality and morbidity exist in both countries, 13 but cause-specific patterns of mortality differ between England and France (cardiovascular disease being most prevalent in British men and neoplasms being most prevalent in French men). Given this pattern, should we expect to find similar social gradients in risk factors for poor health across different cultures, or does the answer lie with culture-specific risk factors? We explored the relations between socioeconomic position, health, and possible risk factors in 2 comparable samples on either side of the English Channel: the Whitehall II Study of British civil servants 14 and the GAZEL Study of personnel at the Gas and Electricity Public Utilities of France. 15 Many measures of morbidity used were identical or very similar, as were potential confounders and mediators. The objectives of this study were to determine (1) whether the social gradient for measures of morbidity and risk factors found among British civil servants was also observed among French public employees and (2) whether the same factors contributed to the gradient in health across the studies. ( Note. In this article the terminology of the Whitehall II Study is used: “spells” refers to periods of time, “sickness absence” to illness-related absence from work.)
