Elstad Jon Ivar, Krokstad Steinar
Norwegian Social Research, Box 3223 Elisenberg, 0208 Oslo, Norway.
Soc Sci Med. 2003 Oct;57(8):1475-89. doi: 10.1016/s0277-9536(02)00514-2.
This study examines how socioeconomic inequalities in perceived health were reproduced as a cohort of adult men became 10 years older, and focuses especially on the role of social causation and health-selective mobility. A two-wave panel data set collected by the Nord-Trøndelag Health Study (HUNT), Norway, is used, and the study is based on a sample of 9189 men aged 25-49 at baseline. Systematic socioeconomic inequalities in perceived health were observed both at baseline and 10 years later when the sample was aged 35-59. Measured as age-adjusted percentage differences, inequalities in perceived health widened during the study period, both among those who were continuously employed and between the employed and non-employed. The pattern of health inequalities was transformed as a result of numerous changes in perceived health and considerable social mobility during the study period. Compared to higher white collar, changes in perceived health during the study period were more negative among medium-level and manual occupations, and even more negative among the non-employed. Mobility between occupational classes among those employed at both observation points was not selective for health, but transitions into and out of employment were strongly health-selective. It is argued that the transformation of the health inequality pattern among those continuously employed was solely due to social causation, i.e., to more negative changes in perceived health among medium/manual occupations than among the white collar. The wider difference in perceived health between the employed and non-employed was, however, primarily a result of health-selective mobility into and out of the non-employed category.
本研究考察了随着一群成年男性年龄增长10岁，感知健康方面的社会经济不平等是如何再现的，并特别关注社会因果关系和健康选择性流动的作用。研究使用了挪威北特伦德拉格健康研究（HUNT）收集的两波面板数据集，样本基于9189名基线年龄在25 - 49岁的男性。在基线时以及10年后样本年龄为35 - 59岁时，均观察到了感知健康方面系统性的社会经济不平等。以年龄调整后的百分比差异衡量，在研究期间，感知健康方面的不平等在持续就业者中以及就业者与非就业者之间都有所扩大。由于研究期间感知健康的诸多变化和相当大的社会流动，健康不平等模式发生了转变。与较高白领职业相比，研究期间感知健康的变化在中等水平职业和体力劳动者中更为负面，在非就业者中则更甚。在两个观察点都有工作的人在职业阶层之间的流动对健康没有选择性，但进入和退出就业则具有很强的健康选择性。研究认为，持续就业者中健康不平等模式的转变完全是由于社会因果关系，即中等/体力职业中感知健康的负面变化比白领职业更多。然而，就业者与非就业者之间在感知健康方面更广泛的差异，主要是健康选择性流动进入和退出非就业类别所致。
