Kroenke Candyce
University of California, San Francisco and Berkeley, CA, USA.
Soc Sci Med. 2008 Jan;66(1):31-42. doi: 10.1016/j.socscimed.2007.07.018. Epub 2007 Sep 14.
There is substantial debate in the field of epidemiology over the theoretical underpinnings of socioeconomic status (SES)-disease mechanisms in the developed world. In particular, it has been debated whether psychosocial mechanisms are important in understanding these relationships, compared with material influences. Within an interdisciplinary context, this review synthesizes the youth development and resilience literatures in examination of this hypothesis. This review provides evidence that both classes of mechanisms are critical to understanding and addressing SES-disease mechanisms over the lifecourse. Research findings demonstrating the effects of these classes of factors point to the complicated and dynamic nature of how SES may impact disease. In the epidemiologic literature, investigators predominantly consider the cumulative impact of biological insults over time. A developmental perspective, however, provides evidence of the importance of psychosocial influences early in life on socioeconomic and health trajectories over the lifecourse. Future epidemiologic research should consider cumulative and developmental influences of early adversity--both psychosocial and material--on later health. This perspective may be particularly relevant to appropriately evaluating the impact of selection and causation in research on SES and disease and will also hopefully provide clarity to this ongoing theoretical debate.
在发达国家，流行病学领域围绕社会经济地位（SES）与疾病机制的理论基础存在大量争论。特别是，相较于物质影响，心理社会机制在理解这些关系中是否重要一直存在争议。在跨学科背景下，本综述综合了青少年发展和复原力方面的文献来检验这一假设。本综述提供的证据表明，这两类机制对于理解和解决生命历程中的SES与疾病机制都至关重要。表明这些类别因素作用的研究结果指出了SES可能影响疾病的复杂和动态性质。在流行病学文献中，研究人员主要考虑生物损伤随时间的累积影响。然而，从发展的角度来看，有证据表明生命早期的心理社会影响对生命历程中的社会经济和健康轨迹具有重要意义。未来的流行病学研究应考虑早期逆境（包括心理社会和物质方面）对后期健康的累积和发展影响。这一观点可能对于恰当地评估研究中选择和因果关系对SES与疾病的影响特别相关，也有望为这场持续的理论争论提供清晰的认识。
