San Sebastian Miguel, Hammarström Anne, Gustafsson Per E
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
BMJ Open. 2015 Aug 28;5(8):e006581. doi: 10.1136/bmjopen-2014-006581.
Socioeconomic inequalities in health are deemed a worldwide public health problem, but current research is lacking on key points including determinants of socioeconomic differences in health, and not the least variations of these determinants over the life course. Using a 26-year prospective Swedish community-based cohort, we aim at decomposing socioeconomic inequalities in functional somatic symptoms by social and material life circumstances, at 4 periods of the life course.
Repeated cross-sectional study.
Participants came from the Northern Swedish Cohort (n=1001), who completed questionnaires about occupational class, social and material living conditions, and symptoms at ages 16, 21, 30 and 42. Socioeconomic inequalities were estimated and decomposed using the Blinder-Oaxaca decomposition analysis.
Inequalities in symptoms between blue-collar and white-collar socioeconomic groups increased along the life course in the sample. In the decomposition analysis, a high proportion of the gap between socioeconomic groups could be explained by social and material living conditions at ages 16 (84% explained), 30 (45%) and 42 (68%), but not at age 21. Specific social (parental illness at age 16 and violence at ages 30 and 42) and material (parental unemployment at age 16, and own unemployment and financial strain at ages 30 and 42) factors contributed jointly to the health gaps.
Socioeconomic inequalities in functional somatic symptoms increased along the life course in this Swedish cohort. A considerable portion of the social gaps in health was explained by concurrent social and material conditions, and the importance of specific adversities was dependent on the life course stage. Our findings suggest that socioeconomic inequalities in functional somatic symptoms may be reduced by addressing both social and material living conditions of disadvantaged families, and also that the life course stage needs to be taken into consideration.
健康方面的社会经济不平等被视为一个全球性的公共卫生问题，但目前的研究在一些关键点上存在不足，包括健康方面社会经济差异的决定因素，以及这些决定因素在生命历程中的变化。我们利用一个为期26年的瑞典社区前瞻性队列，旨在分解生命历程中4个阶段功能性躯体症状方面的社会经济不平等，分解依据为社会和物质生活环境。
重复横断面研究。
参与者来自瑞典北部队列（n = 1001），他们在16岁、21岁、30岁和42岁时完成了关于职业阶层、社会和物质生活条件以及症状的问卷调查。使用布林德-奥瓦萨分解分析来估计和分解社会经济不平等。
在该样本中，蓝领和白领社会经济群体之间的症状不平等在生命历程中有所增加。在分解分析中，社会经济群体之间差距的很大一部分可以由16岁（84%可解释）、30岁（45%）和42岁（68%）时的社会和物质生活条件来解释，但21岁时不行。特定的社会（16岁时父母患病以及30岁和42岁时遭受暴力）和物质（16岁时父母失业以及30岁和42岁时自身失业和经济压力）因素共同导致了健康差距。
在这个瑞典队列中，功能性躯体症状方面的社会经济不平等在生命历程中有所增加。健康方面的社会差距有相当一部分可由同时期的社会和物质条件来解释，而且特定不利因素的重要性取决于生命历程阶段。我们的研究结果表明，通过改善弱势家庭的社会和物质生活条件，功能性躯体症状方面的社会经济不平等可能会减少，同时还需要考虑生命历程阶段。
