Bartley M, Martikainen P, Shipley M, Marmot M
Department of Epidemiology and Public Health, International Center for Health and Society, University College London, 1-19 Torrington Place, London WCIE 6BT, UK.
Soc Sci Med. 2004 Nov;59(9):1925-36. doi: 10.1016/j.socscimed.2004.03.002.
In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases. Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socio-economic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socio-economic position of a female partner than that of a male study participant. Wives' social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants' exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected. Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and 'emotional power' within the household when investigating gender differences in health and risk factors.
在大多数国家，若依据男性伴侣或配偶的职业来衡量女性的社会经济地位，相较于依据女性自身职业衡量，女性的健康不平等状况似乎更为严重。极少有研究表明男性健康会因女性伴侣的职业而呈现出社会梯度差异。本文旨在通过分析自身或配偶（或伴侣）的社会经济地位与一系列常见慢性病风险因素之间的关联，探究男性和女性心血管疾病社会不平等差异的原因。研究参与者为纳入白厅Ⅱ研究的已婚或同居的伦敦公务员。研究参与者的社会经济地位依据公务员等级来衡量；配偶和伴侣的社会经济地位依据总登记官的社会阶层分类标准来衡量。风险因素包括吸烟、饮食、运动、饮酒以及社会支持指标。在任何情况下，风险因素暴露受女性伴侣社会经济地位的影响都不会比受男性研究参与者社会经济地位的影响更大。妻子的社会阶层归属对男性白厅参与者吸烟或极少运动的可能性毫无影响。相比之下，女性参与者的运动情况，尤其是吸烟习惯，独立于其自身就业等级，与配偶的社会阶层相关。饮食质量受男性和女性伴侣社会经济地位的影响程度相同。与行为风险因素不同，女性参与者报告的社会支持程度总体上不会因其丈夫或伴侣处于社会地位较低阶层而受到强烈负面影响。然而，丈夫或伴侣无业与相对较低水平的积极社会支持以及较高水平的消极社会支持相关，而妻子或伴侣无业的男性则未受影响。研究健康不平等中的性别差异更广泛地凸显了健康不平等研究中的一些问题。我们面临这样一个事实，即能够一致应用于男性和女性病因学的概念模型的发展仍处于早期阶段。在调查健康和风险因素的性别差异时，需要更密切关注家庭中物质权力和“情感权力”背后的不同过程。
