Montano Diego
Institute of the History, Philosophy and Ethics of Medicine, Department of Medical Sociology, Ulm University, Parkstr. 11, Ulm, 89073, Germany.
Arch Public Health. 2021 Mar 24;79(1):40. doi: 10.1186/s13690-021-00559-7.
This study seeks to explore potential causal mechanisms involved in the observed associations between several socioeconomic status (SES) indicators, well-being and mortality, by taking a life course perspective focusing on (i) the trajectory of income and domain-specific well-being indicators, (ii) the influence of different SES indicators on well-being and mortality, (iii) the interactions between those trajectories, and (iv) the associations of the income and domain-specific well-being trajectories with all-cause mortality.
Socioeconomic status is operationalised by net household income, education, employment and marital status. Well-being is measured with two indicators: life satisfaction and satisfaction with health. Data from the German Socio-Economic Panel, collected between 1984 and 2016 and comprising more than 55,000 individuals, are analysed by means of longitudinal k-means cluster analysis, simultaneous equation systems and parametric time-to-death regressions.
The analyses indicate the presence of large reciprocal effects of the trajectories of income and well-being on each other. However, the results suggest that well-being has a larger influence on income than the opposite, namely, income on well-being. The mortality analysis, on the other hand, revealed that the history of satisfaction with health is a much stronger predictor of longevity than the individual's income history. Mortality risk was found lower among married individuals and those with tertiary education. In contrast, unemployment was associated with lower income and well-being levels. The findings provide support to the notion that education is a superior SES indicator than income in the investigation of the social determinants of well-being and mortality.
The present study provides evidence of large reciprocal effects of income and well-being and emphasises the importance of taking a life course approach in the investigation of the social determinants of health. Several SES indicators and both well-being indicators were found to be highly predictive of all-cause mortality and indicate the presence of cumulative effects related to one's income and well-being trajectories.
本研究旨在通过采用生命历程视角，探讨几个社会经济地位（SES）指标、幸福感和死亡率之间观察到的关联所涉及的潜在因果机制，该视角关注：（i）收入轨迹和特定领域幸福感指标；（ii）不同SES指标对幸福感和死亡率的影响；（iii）这些轨迹之间的相互作用；（iv）收入和特定领域幸福感轨迹与全因死亡率的关联。
社会经济地位通过家庭净收入、教育程度、就业情况和婚姻状况来衡量。幸福感用两个指标衡量：生活满意度和对健康的满意度。对1984年至2016年收集的、包含超过55000人的德国社会经济面板数据进行纵向k均值聚类分析、联立方程系统分析和参数化死亡时间回归分析。
分析表明收入轨迹和幸福感轨迹之间存在巨大的相互影响。然而，结果表明幸福感对收入的影响大于相反情况，即收入对幸福感的影响。另一方面，死亡率分析表明，健康满意度历史比个人收入历史更能有力地预测长寿。已婚人士和受过高等教育者的死亡风险较低。相比之下，失业与较低的收入和幸福感水平相关。研究结果支持了这样一种观点，即在幸福感和死亡率的社会决定因素调查中，教育是比收入更优越的SES指标。
本研究提供了收入和幸福感存在巨大相互影响的证据，并强调在健康社会决定因素调查中采用生命历程方法的重要性。研究发现，几个SES指标和两个幸福感指标都能高度预测全因死亡率，并表明存在与个人收入和幸福感轨迹相关的累积效应。
