Hegar R, Döring A, Mielck A
Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Neuherberg.
Gesundheitswesen. 2012 May;74(5):306-14. doi: 10.1055/s-0031-1275714. Epub 2011 May 11.
In public health research, social status is usually assessed by objective indicators such as educational level and income. Recent studies have shown the importance of including 'subjective social status (SSS)'. The aim of this study is to analyse the influence of SSS on health for the first time in Germany, and to find out if there is an effect over and above the objective indicators of social status.
The KORA F4 study took place in 2006-2008 in the region of Augsburg, Southern Germany, with a study population of 3 080 men and women aged 32-81 years. SSS was assessed by a single question with 6 possible responses. For the analyses, 3 SSS categories were differentiated: low, middle and high. The following dependent variables were included: self-rated health (SRH), hypertension (uncontrolled), diabetes, metabolic syndrome, hay fever, no participation in medical cancer prevention, obesity (assessed by body mass index and waist-hip-ratio), smoking, physical inactivity. Logistic regression models were used to estimate the influence of SSS (e. g. adjusted for educational level and income).
About 25% of the participants group themselves into the lowest SSS-category. Without adjustment for educational level and income, SSS is negatively associated with SRH, hypertension, diabetes, metabolic syndrome, obesity, no participation in medical cancer prevention, smoking and physical inactivity; as expected the association with hay fever is positive. After adjustment for educational level and income, not all of these associations remain significant. Some of the adjusted odds ratios (OR) for SSS differ considerably when stratified by gender, for example concerning the variable 'physical inactivity': The comparison of 'SSS low' vs. 'SSS high' shows for men OR 2.35 (95% confidence interval (CI) 1.57-3.50) and for women OR 3.58 (95% CI 2.34-5.47).
The results from this study strongly suggest that SSS is an important indicator of social status (to date largely disregarded in public health research). Thus, SSS should be applied in addition to other indicators of social status such as educational level and income. The associations with SSS depend on the health indicator studied. Also, sometimes there are large differences when stratified by gender. Further research is needed to fully understand the determinants of SSS and its impact on health.
在公共卫生研究中，社会地位通常通过教育水平和收入等客观指标来评估。近期研究表明纳入“主观社会地位（SSS）”的重要性。本研究旨在首次分析德国SSS对健康的影响，并查明其在社会地位客观指标之外是否存在影响。
KORA F4研究于2006 - 2008年在德国南部奥格斯堡地区开展，研究对象为3080名年龄在32 - 81岁的男性和女性。SSS通过一个有6种可能回答的单一问题进行评估。分析时，将SSS分为3类：低、中、高。纳入以下因变量：自评健康状况（SRH）、高血压（未控制）、糖尿病、代谢综合征、花粉热、未参与癌症医学预防、肥胖（通过体重指数和腰臀比评估）、吸烟、缺乏身体活动。采用逻辑回归模型估计SSS的影响（如对教育水平和收入进行调整）。
约25%的参与者将自己归入最低的SSS类别。在未对教育水平和收入进行调整时，SSS与SRH、高血压、糖尿病、代谢综合征、肥胖、未参与癌症医学预防、吸烟和缺乏身体活动呈负相关；正如预期的那样，与花粉热的关联为正相关。在对教育水平和收入进行调整后，并非所有这些关联仍具有显著性。当按性别分层时，SSS的一些调整后的优势比（OR）差异很大，例如关于“缺乏身体活动”这一变量：“低SSS”与“高SSS”的比较显示，男性的OR为2.35（95%置信区间（CI）1.57 - 3.50），女性的OR为3.58（95%CI 2.34 - 5.47）。
本研究结果强烈表明，SSS是社会地位的一个重要指标（迄今为止在公共卫生研究中很大程度上被忽视）。因此，除了教育水平和收入等其他社会地位指标外，还应应用SSS。与SSS的关联取决于所研究的健康指标。此外，按性别分层时有时存在很大差异。需要进一步研究以充分了解SSS的决定因素及其对健康的影响。
