社会经济劣势对健康的长期影响：检验感知歧视的中介作用。
Longitudinal health consequences of socioeconomic disadvantage: Examining perceived discrimination as a mediator.
机构信息
Department of Human Development and Family Studies, Auburn University.
Department of Psychology, University of Wisconsin-Madison.
出版信息
Health Psychol. 2018 May;37(5):491-500. doi: 10.1037/hea0000616.
OBJECTIVE
Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual's risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health.
METHOD
Participants in the Midlife in the United States (MIDUS) study were followed over 3 waves covering a 17- to 19-year period (N = 6,286; 53% female; 91% White; mean age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination-perceived inequality in work and everyday discrimination-were considered as mediators.
RESULTS
Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17- to 19-year period (B = -.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages.
CONCLUSION
Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. (PsycINFO Database Record
目的
基础理论观点表明，社会经济地位（SED）的劣势会增加个体遭受不公平待遇或歧视的风险。然而，很少有实证研究关注到感知歧视在 SED 与健康状况梯度之间的作用。为了弥补这一知识空白，本研究考察了歧视在 SED 与自评健康之间的纵向关联中的中介作用。
方法
参与美国中年生活研究（MIDUS）的参与者在 17 至 19 年的 3 个随访阶段中接受了随访（N=6286；53%为女性；91%为白人；基线时的平均年龄为 47 岁，标准差为 13）。SED 由教育、职业声望、收入和资产来评估；自评健康在基线和随访评估时进行测量。工作中感知到的不平等和日常歧视这两种歧视测量方法被视为中介变量。
结果
两种歧视测量方法都成为 SED 与健康之间联系的重要解释变量。基线评估中的 SED 与 17 至 19 年间的自评健康变化有关（B=-.15，p<.001）。歧视的测量方法部分解释了这种纵向关联，解释了总效应的 22%。歧视的暴露及其对健康的影响在年龄较小时更为明显。
结论
需要使用客观健康测量方法对这项研究的结果进行重复研究，并研究可能的干预措施。挑战与社会阶层相关的歧视背后的意识形态和实践，或减轻其有害后果，这两种方法都将是需要考虑的重要方法。
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