Lahelma E, Martikainen P, Laaksonen M, Aittomäki A
Department of Public Health, University of Helsinki, Finland.
J Epidemiol Community Health. 2004 Apr;58(4):327-32. doi: 10.1136/jech.2003.011148.
Many previous studies on socioeconomic inequalities in health have neglected the causal interdependencies between different socioeconomic indicators. This study examines the pathways between three socioeconomic determinants of ill health.
DESIGN, SETTING, AND PARTICIPANTS: Cross sectional survey data from the Helsinki health study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55, and 60 years received a mailed questionnaire. Altogether 6243 employees responded (80% women, response rate 68%). Socioeconomic indicators were education, occupational class, and household income. Health indicators were limiting longstanding illness and self rated health. Inequality indices were calculated based on logistic regression analysis.
Each socioeconomic indicator showed a clear gradient with health. Among women half of inequalities in limiting longstanding illness by education were mediated through occupational class and household income. Inequalities by occupational class were largely explained by education. A small part of inequalities for income were explained by education and occupational class. For self rated health the pathways were broadly similar. Among men most of the inequalities in limiting longstanding illness by education were mediated through occupational class and income. Part of occupational class inequalities were explained by education. Two thirds of inequalities by income were explained by education and occupational class.
Parts of the effects of each socioeconomic indicator on health are either explained by or mediated through other socioeconomic indicators. Analyses of the predictive power of socioeconomic indicators on health run the risk of being fruitless, if interrelations between various indicators are neglected.
以往许多关于健康方面社会经济不平等的研究都忽略了不同社会经济指标之间的因果相互依存关系。本研究探讨了健康状况不佳的三个社会经济决定因素之间的路径。
设计、背景和参与者：使用了2000年和2001年赫尔辛基健康研究的横断面调查数据。每年，赫尔辛基市40、45、50、55和60岁的员工会收到邮寄的调查问卷。共有6243名员工做出回应（80%为女性，回应率68%）。社会经济指标为教育程度、职业阶层和家庭收入。健康指标为长期限制性生活的疾病和自我评定的健康状况。基于逻辑回归分析计算不平等指数。
每个社会经济指标都与健康呈现出明显的梯度关系。在女性中，因教育程度导致的长期限制性生活疾病不平等现象，有一半是通过职业阶层和家庭收入介导的。职业阶层导致的不平等在很大程度上可由教育程度来解释。收入不平等的一小部分可由教育程度和职业阶层来解释。对于自我评定的健康状况，路径大致相似。在男性中，因教育程度导致的长期限制性生活疾病不平等现象，大部分是通过职业阶层和收入介导的。职业阶层不平等的一部分可由教育程度来解释。收入不平等的三分之二可由教育程度和职业阶层来解释。
每个社会经济指标对健康的部分影响要么由其他社会经济指标解释，要么通过其他社会经济指标介导。如果忽略各种指标之间的相互关系，分析社会经济指标对健康的预测能力可能会徒劳无功。
