School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile.
Canada Research Chair in Health Disparities, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
Int J Public Health. 2017 Dec;62(9):1007-1017. doi: 10.1007/s00038-017-0996-z. Epub 2017 Jun 27.
We estimated the roles of childhood socioeconomic position (ChSEP) and education attainment on chronic diseases in Chilean adults, mediated through structural determinants and health behaviors, to identify potential pro-equity interventions.
We analyzed Chile's longitudinal Social Protection Surveys, a national sample of 14,788 adults with follow-up to 2009. Controlled direct effects (CDE) and natural effects (NDE and NIE) of ChSEP and education on number of chronic diseases were estimated with negative binomial models.
CDE of low ChSEP with education fixed at 12 years showed a 12% increase with 4% indirect effects. CDEs at favorable levels of BMI, smoking, alcohol use, and physical activity were similar. CDE estimates for education adjusted for ChSEP were larger with negligible mediation. CDEs for women were generally larger.
Low ChSEP exerts a primarily direct effect on later chronic disease, modestly mediated by education. Education attainment showed larger direct effects with minimal mediation by behaviors. Strengthening current-early child development and education policies, particularly gender aspects, may reduce social inequalities and key pathways for reducing chronic disease inequalities in Chile.
我们评估了智利成年人的童年社会经济地位（ChSEP）和教育程度对慢性病的作用，这些作用通过结构决定因素和健康行为来介导，以确定潜在的公平干预措施。
我们分析了智利的纵向社会保护调查，这是一个全国性的 14788 名成年人样本，随访至 2009 年。使用负二项式模型估计 ChSEP 和教育对慢性病数量的直接控制效应（CDE）和自然效应（NDE 和 NIE）。
在 BMI、吸烟、饮酒和身体活动处于有利水平的情况下，ChSEP 的 CDE 相似。调整 ChSEP 的教育的 CDE 估计值较大，中介作用可忽略不计。女性的 CDE 通常更大。
低 ChSEP 对以后的慢性病主要产生直接影响，教育适度介导。教育程度通过行为的最小中介作用表现出更大的直接影响。加强当前的儿童早期发展和教育政策，特别是性别方面的政策，可能会减少智利的社会不平等和减少慢性病不平等的关键途径。
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