Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
BMC Public Health. 2013 Jul 17;13:665. doi: 10.1186/1471-2458-13-665.
The past decade has seen a vast increase in empirical research investigating associations between social capital and health outcomes. Literature reviews reveal 'generalized trust' and 'social participation' to be the most robust of the commonly used social capital proxies, both showing positive association with health outcomes. However, this association could be confounded by unmeasured factors, such as the shared environment. Currently, there is a distinct lack of social capital research that takes into account such residual confounding.
Using data from the United Kingdom's British Household Panel Survey (BHPS) (waves thirteen to eighteen, N = 6982), this longitudinal, multilevel study investigates the validity of the association between trust, social participation and self-rated health using a family-based design. As the BHPS samples on entire households, we employed 'mean' and 'difference from the mean' aggregate measures of social capital, the latter of which is considered a social capital measurement that is not biased by the shared environment of the household. We employed Generalized Estimating Equations for all analyses, our two-level model controlling for correlation at the household level.
Results show that after adjusting for the shared environment of the household over a six year period, the association between social participation and self-rated health was fully attenuated (OR = 0.97 (95% confidence interval 0.89-1.06)), while the association with trust remained significant (OR = 1.11 (1.02-1.20)). Other health determinants, such as being a smoker, having no formal qualifications and being unemployed maintain their associations with poor self-rated health.
The association between social capital (specifically trust and social participation) and self-rated health appear to be confounded by shared environmental factors not previously considered by researchers. However, the association with trust remains, adding to existing empirical evidence that generalized trust may be an independent predictor of health.
过去十年中，实证研究大量涌现，旨在探究社会资本与健康结果之间的关联。文献综述表明，“普遍信任”和“社会参与”是最常用的社会资本代理指标中最稳健的两个，两者均与健康结果呈正相关。然而，这种关联可能受到未被测量的因素（如共同环境）的影响。目前，很少有考虑到这种残余混杂因素的社会资本研究。
本纵向、多水平研究使用来自英国家庭面板调查（BHPS）（第 13 至 18 波，N=6982）的数据，采用基于家庭的设计，调查信任、社会参与和自评健康之间关联的有效性。由于 BHPS 对整个家庭进行抽样，我们采用了“均值”和“偏离均值”两种社会资本综合衡量指标，后者被认为是一种不受家庭共同环境影响的社会资本衡量指标。我们对所有分析都采用了广义估计方程，我们的两层模型控制了家庭层面的相关性。
结果表明，在调整家庭共同环境后，在六年的时间内，社会参与与自评健康之间的关联完全减弱（OR=0.97（95%置信区间 0.89-1.06）），而与信任的关联仍然显著（OR=1.11（1.02-1.20））。其他健康决定因素，如吸烟、没有正式资格和失业，仍然与自评健康不良有关。
社会资本（特别是信任和社会参与）与自评健康之间的关联似乎受到以前研究人员未考虑的共同环境因素的影响。然而，与信任的关联仍然存在，这增加了现有的实证证据，即普遍信任可能是健康的独立预测因素。
