Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Soc Sci Med. 2012 Mar;74(6):930-9. doi: 10.1016/j.socscimed.2011.11.026. Epub 2012 Jan 21.
Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health.
社会结构和社会经济模式是人口健康的主要决定因素。然而，以前很少有研究在探讨健康的社会决定因素时同时分析“社会”和“经济”指标。我们通过分析各种指标，关注经济和社会资本作为健康决定因素的相关性。本文的目的是分析缺乏经济资本（经济困难）和社会资本（社会参与、人际和政治/制度信任）对各种健康结果的独立关联和相互作用。数据来自 2009 年瑞典国家公共卫生调查，该调查基于随机选择的 23153 名男性和 28261 名 16-84 岁女性的代表性样本，参与率为 53.8%。经济困难通过包括家庭收入低、无法支付开支和缺乏现金储备在内的综合经济困难措施来衡量。社会资本通过社会参与、人际（水平）信任和对议会的政治（垂直/制度）信任来衡量。健康结果包括：（i）自评健康，（ii）心理困扰（GHQ-12）和（iii）肌肉骨骼疾病。多变量逻辑回归结果表明，经济资本和低社会资本的两个衡量标准都与健康状况不佳显著相关，只有少数例外。观察到经济困难和各种类型的社会资本之间存在显著的交互作用，表现为协同指数。协同指数范围从 1.4 到 2.3。本研究增加了证据表明，经济困难和社会资本都有助于一系列不同的健康结果。此外，当它们结合在一起时，会增加健康状况不佳的风险。
