Epidemiology, University of Washington, Seattle, Washington, USA
Epidemiology, University of Washington, Seattle, Washington, USA.
J Epidemiol Community Health. 2020 May;74(5):453-459. doi: 10.1136/jech-2019-213440. Epub 2020 Feb 21.
We used a relational social-class measure based on property ownership and managerial authority to analyse the longitudinal relationships between class, self-rated health (SRH) and mental illness. To our knowledge, this is the first study using a relational social-class measure to evaluate these relationships longitudinally.
Using Panel Study of Income Dynamics data from 1984 to 2017, we first assigned respondents aged 25-64 to the not in the labour force (NILF), worker, manager, petit bourgeois (PB) or capitalist classes based on business ownership, managerial authority and employment status. Next, using Cox models, we estimated the confounder-adjusted associations between 2-year-lagged class and incidence of poor/fair SRH and serious mental illness. We also tested whether the associations varied by gender, whether they persisted after more-fully adjusting for traditional socioeconomic-status measures (education and income) and how they changed temporally.
We identified large inequities in poor/fair SRH. NILFs had the greatest hazard, followed by workers, PBs, managers and capitalists. We also identified large inequities in serious mental illness; NILFs and workers had the greatest hazard, while capitalists had the lowest. Class inequities in both outcomes lessened but remained considerable after confounder and socioeconomic-status adjustment, and we found some evidence that the class-SRH relationship varied by gender, as being NILF was more harmful among men than women. Additionally, class inequities in the outcomes decreased somewhat over time.
We identified substantial class inequities in SRH and mental illness. Our findings demonstrate the importance of using relational social-class measures to deepen understanding of health inequities' root causes.
我们使用基于财产所有权和管理权限的关系社会阶层衡量标准来分析阶层、自评健康（SRH）和精神疾病之间的纵向关系。据我们所知，这是第一项使用关系社会阶层衡量标准来纵向评估这些关系的研究。
使用 1984 年至 2017 年的收入动态面板研究数据，我们首先根据企业所有权、管理权限和就业状况将 25-64 岁的受访者分配到非劳动力（NILF）、工人、经理、小资产阶级（PB）或资本家阶层。接下来，我们使用 Cox 模型估计了 2 年滞后的阶层与不良/一般自评健康和严重精神疾病发病率之间的混杂因素调整关联。我们还检验了这些关联是否因性别而异，是否在更充分地调整传统社会经济地位衡量标准（教育和收入）后仍然存在，以及它们如何随时间变化。
我们发现自评健康状况不佳存在很大的不公平现象。NILF 阶层的危险度最高，其次是工人阶层、PB 阶层、经理阶层和资本家阶层。我们还发现严重精神疾病存在很大的不公平现象；NILF 和工人阶层的危险度最高，而资本家阶层的危险度最低。在混杂因素和社会经济地位调整后，这两种结果的阶层不公平现象有所减少，但仍相当可观，我们发现有一些证据表明，阶层与 SRH 的关系因性别而异，因为 NILF 对男性的危害大于女性。此外，这些结果的阶层不公平现象随着时间的推移略有减少。
我们发现自评健康和精神疾病存在显著的阶层不公平现象。我们的研究结果表明，使用关系社会阶层衡量标准对于深入了解健康不公平现象的根本原因具有重要意义。
