Varghese Jithin Sam, Hall Rachel Waford, DiGirolamo Ann M, Martorell Reynaldo, Ramirez-Zea Manuel, Stein Aryeh D
Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
SSM Popul Health. 2021 Jul 21;15:100880. doi: 10.1016/j.ssmph.2021.100880. eCollection 2021 Sep.
We study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes.
We use data from participants of the INCAP Longitudinal Study 1969-2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS).
Median participant rating was 5 [IQR: 3-8] for the perceived community respect and 3 [IQR: 1-5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (-0.28, 95 % CI: -0.47, -0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator.
Subjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways.
我们研究生命历程中的客观社会经济地位（SEP）如何预测主观社会地位（SSS），以及SSS在多大程度上介导客观SEP与营养状况和心理健康结果之间的关联。
我们使用了危地马拉1969 - 2018年INCAP纵向研究参与者的数据（n = 1258）。我们使用麦克阿瑟阶梯量表来衡量SSS的两个方面——感知到的社区尊重和感知到的经济地位。我们通过线性回归，在调整了早期生活特征和生命历程中的客观SEP（财富、教育程度、就业情况）后，估计SSS与健康结果之间的关联。我们使用路径分析来研究SSS对体重指数（BMI；kg/m）、心理困扰（使用世界卫生组织自填问卷；SRQ - 20）和幸福感（使用主观幸福感量表；SHS）等健康结果的中介程度。
参与者对感知到的社区尊重的中位数评分为5[四分位间距：3 - 8]，对感知到的经济地位的中位数评分为3[四分位间距：1 - 5]，且不存在性别差异。早期生活和成年期的客观SEP能够预测中年期的SSS指标以及健康结果（BMI、SRQ - 20和SHS）。感知到的社区尊重（z分数；1个z = 3.1个单位）与幸福感呈正相关（0.13，95%置信区间：0.07，0.19）。感知到的经济地位（z分数；1个z = 2.3个单位）与心理困扰呈负相关（-0.28，95%置信区间：-0.47，-0.09）。SSS的这两个指标均与BMI无关。将感知到的社区尊重和感知到的经济地位作为中介纳入分析后，它们均未减弱客观SEP与健康结果之间的关联。
在调整了客观SEP后，主观社会地位在中年期与幸福感和心理困扰独立相关。此外，客观SEP与健康之间的关联并未由SSS介导，这表明可能存在独立的途径。
