Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
Department of Epidemiology and Health Promotion and Institute of Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
J Epidemiol Community Health. 2018 Jun;72(6):545-551. doi: 10.1136/jech-2017-209131. Epub 2018 Feb 19.
The relationship between socioeconomic status and mortality has been well established; however, the extent to which biological factors mediate this relationship is less clear, and empirical evidence from non-Western settings is limited. Allostasis, a cumulative measure of physiological dysregulation, has been proposed as the underlying mechanism linking socioeconomic status to adverse health outcomes. The current study aimed to ascertain the contribution of allostatic load (AL) and health behaviours to socioeconomic inequalities in mortality among Korean adults.
The sample comprised 70 713 middle-aged and older-aged adults, aged 40-79 years from the Korean Metabolic Syndrome Mortality Study. Using structural equation modelling (SEM), mediation analyses were performed to estimate the effects of socioeconomic position (SEP) on mortality over the follow-up and the extent to which AL, physical exercise and non-smoking status mediate the association between SEP and mortality.
A total of 5618 deaths (7.9%) occurred during the mean follow-up of 15.2 years (SD 2.9). SEM confirmed a direct significant effect of SEP on mortality, as well as significant indirect paths through AL, physical exercise and non-smoking status.
Our findings provide support for the mediating role of AL and health behaviours in the link between SEP and mortality. Policies designed to reduce social disparities in mortality in the long term should primarily focus on reducing stress and promoting healthy lifestyles among the socially disadvantaged groups. Future studies should further assess the role of other mediators such as psychosocial factors, which may contribute to socioeconomic inequalities in mortality.
社会经济地位与死亡率之间的关系已得到充分证实；然而，生物因素在多大程度上调节这种关系尚不清楚，来自非西方环境的经验证据也有限。适应（allostasis），即生理失调的累积衡量标准，被认为是将社会经济地位与不良健康结果联系起来的潜在机制。本研究旨在确定韩国成年人中，总体适应负荷（allostatic load，AL）和健康行为在社会经济地位与死亡率之间的不平等关系中的作用。
本研究样本包括韩国代谢综合征死亡率研究中的 70713 名中年和老年成年人，年龄在 40-79 岁之间。采用结构方程模型（structural equation modelling，SEM），进行中介分析以估计社会经济地位（socioeconomic position，SEP）对死亡率的影响，并评估 AL、体育锻炼和不吸烟状况在 SEP 和死亡率之间的关联中的中介作用。
在平均 15.2 年（标准差 2.9）的随访期间，共有 5618 人死亡（7.9%）。SEM 证实了 SEP 对死亡率有直接显著影响，并且通过 AL、体育锻炼和不吸烟状况存在显著的间接路径。
本研究结果支持 AL 和健康行为在 SEP 和死亡率之间的关联中起中介作用。从长远来看，旨在减少社会不平等死亡率的政策应主要侧重于减少社会劣势群体的压力和促进健康的生活方式。未来的研究应进一步评估其他中介因素（如心理社会因素）的作用，这些因素可能导致死亡率的社会经济不平等。
