Kröger Hannes, Pakpahan Eduwin, Hoffmann Rasmus
Department of Political and Social Sciences, European University Institute, Via dei Roccettini, 9, 50014 San Domenico di Fiesole, Italy
Department of Political and Social Sciences, European University Institute, Via dei Roccettini, 9, 50014 San Domenico di Fiesole, Italy.
Eur J Public Health. 2015 Dec;25(6):951-60. doi: 10.1093/eurpub/ckv111. Epub 2015 Jun 18.
The social gradient in health is one of the most reliable findings in public health research. The two competing hypotheses that try to explain this gradient are known as the social causation and the health selection hypothesis. There is currently no synthesis of the results of studies that test both hypotheses.
We provide a systematic review of the literature that has addressed both the health selection and social causation hypotheses between 1994 and 2013 using seven databases following PRISMA rules.
The search strategy resulted in 2952 studies, of which, we included 34 in the review. The synthesis of these studies suggests that there is no general preference for either of the hypotheses (12 studies for social causation, 10 for health selection). However, both a narrative synthesis as well as meta-regression results show that studies using indicators for socio-economic status (SES) that are closely related to the labor market find equal support for health selection and social causation, whereas indicators of SES like education and income yield results that are in favor of the social causation hypothesis. High standards in statistical modeling were associated with more support for health selection.
The review highlights the fact that the causal mechanisms behind health inequalities are dependent on whether or not the dimension being analyzed closely reflects labor market success. Additionally, further research should strive to improve the statistical modeling of causality, as this might influence the conclusions drawn regarding the relative importance of health selection and social causation.
健康方面的社会梯度是公共卫生研究中最可靠的发现之一。试图解释这一梯度的两个相互竞争的假说是社会因果关系假说和健康选择假说。目前尚无对检验这两种假说的研究结果进行综合分析。
我们按照PRISMA规则，使用七个数据库对1994年至2013年间涉及健康选择和社会因果关系假说的文献进行了系统综述。
检索策略共得到2952项研究，其中我们纳入了34项进行综述。这些研究的综合分析表明，对于这两种假说并没有普遍的偏好（支持社会因果关系假说的有12项研究，支持健康选择假说的有10项）。然而，叙述性综合分析以及元回归结果均显示，使用与劳动力市场密切相关的社会经济地位（SES）指标的研究对健康选择和社会因果关系假说的支持程度相同，而像教育和收入这样的SES指标得出的结果则支持社会因果关系假说。统计建模的高标准与对健康选择假说的更多支持相关。
该综述突出了这样一个事实，即健康不平等背后的因果机制取决于所分析的维度是否紧密反映劳动力市场的成功。此外，进一步的研究应努力改进因果关系的统计建模，因为这可能会影响关于健康选择和社会因果关系相对重要性的结论。
