Huang Rui, Grol-Prokopczyk Hanna
University at Buffalo, State University of New York, Buffalo, NY, USA.
SSM Popul Health. 2022 Mar 12;17:101069. doi: 10.1016/j.ssmph.2022.101069. eCollection 2022 Mar.
Fundamental Cause Theory (FCT) predicts that higher socioeconomic status (SES) leads to better health outcomes, through mechanisms including health-promoting behaviors. Most studies supporting FCT use data from Western countries. However, limited empirical studies from China, as well as theoretical considerations suggested by China's unique history and culture, raise questions about the generalizability of FCT to the Chinese context. This study explores whether the associations between SES, health behaviors, and health status in Western countries are also observed in China, and to what extent behavioral risk factors explain socioeconomic disparities in Chinese health.
Using data on adults age 45+ from the nationally-representative 2015 China Health and Retirement Longitudinal Study (CHARLS; n = 14,420), we conduct regressions of multiple health outcomes (self-rated health, disease count, and several common chronic conditions) on demographic characteristics, SES (measured via education and wealth), and behavioral risk factors (smoking, high-frequency drinking, and overweight). To assess whether behavioral risk factors mediate the SES-health association, we use the Karlson, Holm and Breen (KHB) mediation analysis method.
Supporting FCT, both education and wealth predict higher self-rated health and lower risk of arthritis. However, inconsistent with FCT, neither education nor wealth predict disease count, diabetes, or hypertension; education shows some positive association with cardiovascular disease; and higher SES is strongly associated with higher risk of dyslipidemia. Prevalence of smoking and high-frequency drinking are flat by wealth and inversely U-shaped by education, while overweight is somewhat concentrated in the highest SES groups. Results of mediation analyses show both suppression and mediation effects.
High prevalence of behavioral risk factors across SES groups appears to damage health in much of the Chinese population, and thus attenuates social gradients in health. A broader range of cultural, historical, and political factors should be incorporated into FCT's theoretical framework, particularly in non-Western contexts.
根本原因理论（FCT）预测，较高的社会经济地位（SES）通过包括促进健康行为在内的机制，会带来更好的健康结果。大多数支持FCT的研究使用来自西方国家的数据。然而，来自中国的实证研究有限，以及中国独特的历史和文化所提出的理论考量，引发了关于FCT在中国背景下的可推广性的疑问。本研究探讨在西方国家中观察到的SES、健康行为和健康状况之间的关联在中国是否也存在，以及行为风险因素在多大程度上解释了中国健康方面的社会经济差异。
利用具有全国代表性的2015年中国健康与养老追踪调查（CHARLS；n = 14420）中45岁及以上成年人的数据，我们对多种健康结果（自评健康、疾病数量以及几种常见慢性病）进行回归分析，这些结果受人口统计学特征、SES（通过教育和财富衡量）以及行为风险因素（吸烟、高频饮酒和超重）的影响。为了评估行为风险因素是否介导了SES与健康之间的关联，我们使用卡尔森、霍尔姆和布林（KHB）中介分析方法。
支持FCT的是，教育和财富都预示着较高的自评健康水平和较低的关节炎风险。然而，与FCT不一致的是，教育和财富都不能预测疾病数量、糖尿病或高血压；教育与心血管疾病呈现出一些正相关；较高的SES与较高的血脂异常风险密切相关。吸烟和高频饮酒的患病率随财富水平呈平稳态势，随教育程度呈倒U形，而超重情况在最高SES群体中相对集中。中介分析结果显示出抑制和中介效应。
SES各群体中行为风险因素的高流行率似乎损害了中国大部分人口的健康，从而削弱了健康方面的社会梯度。应将更广泛的文化、历史和政治因素纳入FCT的理论框架，特别是在非西方背景下。
