Klokgieters Silvia Simone, Huisman Martijn, van Groenou Marjolein Broese, Kok Almar Andreas Leonardus
Department of Epidemiology & Biostatistics, Amsterdam UMC - Location VU University Medical Center, De Boelelaan 1089a, 1081 HV, Amsterdam, the Netherlands.
Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
BMC Public Health. 2021 Jan 19;21(1):155. doi: 10.1186/s12889-020-10154-0.
Although the educational expansion is often seen as a mechanism that might reduce health inequalities, socioeconomic inequalities in health (SEIH) have persisted or increased over the past decades. Theories suggest that this persistence could be due to a changing role of education as a 'gatekeeper' to access other socioeconomic resources such as occupation and income that are also associated with health outcomes. To test this, we examine whether the mediating role of occupation and income in the education-health relationship differs between three cohorts of 55-64 year old adults.
We used cross-sectional data from three cohorts of 988, 1002, and 1023 adults born in 1928/37, 1938/47 and 1948/57 and observed in 1992/93, 2002/03, 2012/13 respectively, who participated in the Longitudinal Aging Study Amsterdam, the Netherlands. We used multigroup structural equation modelling to compare the strength of indirect effects of education via occupational skill level and income to functional limitations and depressive symptoms between cohorts.
Absolute educational inequalities in functional limitations increased for men and women in later cohorts, and in depressive symptoms only for men. Relative inequalities in functional limitations increased only for women and in depressive symptoms only for men. The indirect effect of education via income on both health outcomes was weaker in the most recent birth cohort compared to the earlier cohorts. In contrast, the indirect effect of education via occupation on functional limitations was stronger in the most recent cohort compared to the earlier cohorts. These differences were mainly due to a decreasing direct effect of education on income and an increasing direct effect of education on occupational skill level, rather than to changes in the direct effects of occupation and income on health.
The role of education in determining inequalities in health appears to have changed across cohorts. While education became a less important determinant of income, it became a more important determinant of occupational level. This changing role of education in producing health inequalities should be considered in research and policy.
尽管教育扩张通常被视为一种可能减少健康不平等的机制，但在过去几十年中，健康方面的社会经济不平等（SEIH）一直持续存在或有所加剧。理论表明，这种持续性可能是由于教育作为获取其他社会经济资源（如职业和收入）的“守门人”的角色发生了变化，而这些资源也与健康结果相关。为了验证这一点，我们研究了职业和收入在教育与健康关系中的中介作用在三组55 - 64岁成年人中是否存在差异。
我们使用了来自三组分别出生于1928/37、1938/47和1948/57年的成年人的横断面数据，他们分别在1992/93年、2002/03年和2012/13年接受观察，这些人参与了荷兰阿姆斯特丹纵向老龄化研究。我们使用多组结构方程模型来比较不同队列中教育通过职业技能水平和收入对功能受限和抑郁症状的间接影响强度。
在较晚队列中，男性和女性在功能受限方面的绝对教育不平等有所增加，而在抑郁症状方面仅男性有所增加。功能受限方面的相对不平等仅在女性中增加，抑郁症状方面仅在男性中增加。与早期队列相比，教育通过收入对两种健康结果的间接影响在最新出生队列中较弱。相反，与早期队列相比，教育通过职业对功能受限的间接影响在最新队列中较强。这些差异主要是由于教育对收入的直接影响下降以及教育对职业技能水平的直接影响增加，而不是职业和收入对健康的直接影响发生了变化。
教育在决定健康不平等方面的作用似乎在不同队列中发生了变化。虽然教育成为收入的一个不太重要的决定因素，但它成为职业水平的一个更重要的决定因素。在研究和政策中应考虑教育在产生健康不平等方面的这种变化作用。
