Hay D I
Department of Behavioural Science, University of Toronto, Ontario, Canada.
Soc Sci Med. 1988;27(12):1317-25. doi: 10.1016/0277-9536(88)90196-7.
The relationships between education/occupation/income and health status have been well documented in the international epidemiological and sociological literature for many years, however, specific studies on the subject are scarce in Canada. Even when relationships have been demonstrated, the reasons for these relationships are much debated. This study presents an analysis of the relationship between socioeconomic status (SES) and health status. The study is based on analysis of data from a sample of nearly 2000 male principal income earners from the 1978 Canada Health Survey. Firstly, is there a relationship between an individual's SES and health status in Canada? Secondly, what aspects of SES--education, occupational status, and/or income--are most important? Thirdly, what are the possible explanations of the observed relationship? That is, is it possible to disaggregate the relationship and thereby infer possible causal mechanisms? The findings indicated a direct positive relationship between SES and health status, i.e. the higher an individual's SES, the better that person's health. The major exception to this was the SES/fitness relationship. In this instance, the higher the SES, the lower the level of fitness. Though age was an important control variable as SES, fitness and illness are age related, the findings relating SES to the health measures remained even when age was controlled for. Of the three SES measures, income was consistently the best correlate of health status. Occupational status showed the most inconsistent relationships with health status. The findings supported both the social causation and social selection hypotheses. That is, social position can have an effect on health status (social causation), while health status can affect one's social position (social selection).
教育、职业、收入与健康状况之间的关系在国际流行病学和社会学文献中已有多年充分记载,然而,加拿大在这一主题上的具体研究却很匮乏。即便已证实存在某些关系,但这些关系背后的原因仍备受争议。本研究对社会经济地位(SES)与健康状况之间的关系进行了分析。该研究基于对1978年加拿大健康调查中近2000名男性主要收入者样本数据的分析。首先,在加拿大,个人的社会经济地位与健康状况之间是否存在关联?其次,社会经济地位的哪些方面——教育、职业地位和/或收入——最为重要?第三,如何解释所观察到的这种关系?也就是说,是否有可能剖析这种关系,进而推断出可能的因果机制?研究结果表明社会经济地位与健康状况之间存在直接的正相关关系,即个人的社会经济地位越高,其健康状况越好。唯一的主要例外是社会经济地位与健康体能的关系。在这种情况下,社会经济地位越高,健康体能水平越低。尽管年龄是一个重要的控制变量,因为社会经济地位、健康体能和疾病都与年龄相关,但即便对年龄进行了控制,社会经济地位与健康指标之间的关系依然成立。在社会经济地位的三项衡量指标中,收入始终是与健康状况关联度最高的。职业地位与健康状况之间的关系最为不稳定。研究结果支持了社会因果关系和社会选择这两种假设。也就是说,社会地位会对健康状况产生影响(社会因果关系),而健康状况也会影响一个人的社会地位(社会选择)。