The Institute for Social Research and Social Policy, Cologne, Germany.
Faculty of Human Sciences and Faculty of Medicine, The Institute of Medical Sociology Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany.
J Public Health (Oxf). 2018 Sep 1;40(3):e235-e243. doi: 10.1093/pubmed/fdx180.
Whereas the association between education and health in later life is well described, investigations about the underlying mechanisms of these health inequalities are scarce. This study examines the relative contribution of material, behavioral and psychosocial factors to health inequalities in older Germans.
Data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample included 3246 participants aged 60-85 years. We examined the independent and indirect contribution of material, behavioral and psychosocial factors to the association between education and self-rated health based on logistic regression models.
Material factors were most important as they were additionally working through behavioral and psychosocial factors whereas the independent contribution of behavioral and psychosocial factors was much lower than suggested in the separate analyses of the three explanatory pathways.
Policy interventions that focus on the improvement of material living conditions might reduce health inequalities in old age. In studies on the underlying mechanisms of health inequalities, material, behavioral and psychosocial factors should be modeled as inter-related predictors as the separate analysis does not reveal their actual contribution so that the relevance of single explanatory pathways might be overestimated.
尽管人们对晚年的教育与健康之间的关系已有较为详尽的描述，但对这些健康不平等现象背后的机制的研究却很少。本研究旨在探讨物质、行为和心理社会因素对德国老年人健康不平等的相对贡献。
本研究的数据来自欧洲健康、老龄化和退休调查（SHARE）的第五波调查。分析样本包括 3246 名 60-85 岁的参与者。我们根据逻辑回归模型，检验了物质、行为和心理社会因素对教育与自评健康之间关联的独立和间接贡献。
物质因素最重要，因为它们通过行为和心理社会因素起作用，而行为和心理社会因素的独立贡献远低于在三个解释途径的单独分析中所表明的。
注重改善物质生活条件的政策干预措施可能会减少老年人的健康不平等。在研究健康不平等现象背后的机制时，物质、行为和心理社会因素应作为相互关联的预测因素进行建模，因为单独分析并不能揭示它们的实际贡献，从而可能高估单一解释途径的相关性。
