摘要：Objectives. To investigate the effect of social mobility and to assess the use of socioeconomic indicators in monitoring health inequities over time, we examined the association of self-rated health with socioeconomic position over the life course. Methods. Data came from a cross-sectional telephone survey (n = 2999) that included life-course socioeconomic indicators and from a chronic disease and risk factor surveillance system (n = 26 400). Social mobility variables, each with 4 possible intergenerational trajectories, were constructed from family financial situation and housing tenure during childhood and adulthood. Results. Low socioeconomic position during both childhood and adulthood and improved financial situation in adulthood were associated with a reduced prevalence of excellent or very good health. Trends over time indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health. Conclusions. Our results support policies aiming to improve family financial situation during childhood and housing tenure across the life course. Inclusion of life-course socioeconomic measures in surveillance systems would enable monitoring of health inequities trends among socially mobile groups. Monitoring and surveillance form an important part of the international health inequities agenda. 1 It is necessary to monitor health inequities in terms of socioeconomic position (SEP), gender, ethnicity, and other indicators to determine whether they are widening or decreasing over time 2 and to design and evaluate policies aimed at reducing these inequities. Researchers have noted the paucity of data for monitoring inequities over time and called for the focus of such monitoring to be broadened from mortality to include health, morbidity, and risk indicators. 2 , 3 Routine data from population health surveys and surveillance systems can be used to monitor epidemiological changes in health inequities. The US Behavioral Risk Factor Surveillance System is known as one of the most extensive population survey systems for monitoring morbidity and risk factors among different population groups over time. 4 – 6 Other systems for monitoring health include the Demographic Surveillance Systems in 19 countries across Africa, Asia, Oceania, and Central America 7 ; the Multiple Indicator Cluster Surveys across 64 countries 8 ; the Demographic and Health Surveys typically conducted every 5 years in more than 75 countries 9 ; and the Netherlands Permanent Research on Living Conditions annual surveys. 2 In Australia, the South Australian Monitoring and Surveillance System (SAMSS) 10 is an example of a statewide system that regularly and frequently collects, analyses, interprets, and disseminates data. 11 , 12 Many surveillance systems use measures of current SEP to monitor inequities in health. It is widely acknowledged that SEP across the life course influences health 13 and that observational studies of socially patterned exposures and outcomes should adjust for measures of SEP across the life course, 14 but indicators of early-life SEP have not yet been included in population survey monitoring systems. Longitudinal cohort studies have been the preeminent design in life-course epidemiology; the indicators of life-course SEP used in these studies have not generally been applied in a surveillance context. Measuring SEP at more than 1 point over the life course allows investigation into how social mobility, both upward and downward, is associated with health outcomes. The success of policies aiming to redress the health effects of disadvantage in early life and to protect against challenges in later life can be monitored and evaluated if SEP over the life course is measured in surveillance systems. A commonly used indicator to examine health inequities is self-rated health. Studies of the 1958 National Child Development Study British birth cohort demonstrated that lifetime socioeconomic circumstances accounted for inequities in self-rated health. 15 , 16 Four European studies found stronger associations for SEP in adulthood with self-rated health than with childhood SEP, although this varied by country and gender. 17 Trends in Finland showed improvements in self-rated health between 1972 and 1992, and inequities in self-rated health by education and income decreased over this period. 18 No studies have examined trends in self-rated health among groups who have experienced socioeconomic disadvantage over the life course—whether they have experienced cumulative disadvantage throughout childhood and adulthood or upward or downward social mobility. We analyzed data from a cross-sectional representative population survey to examine the prevalence of self-rated excellent or very good health among people who were socially mobile (upward or downward) between childhood and adulthood, with retrospectively recalled information about childhood SEP. We also analyzed surveillance data collected continuously between 2002 and 2007 to measure the prevalence of self-rated excellent or very good health among different socioeconomic groups over time and to evaluate the potential of life-course SEP indicators in surveillance systems to help monitor the direction of inequities in health among socially mobile and stable groups.
