工作和与健康相关的生活方式对德国老年工人身体健康教育不平等的贡献。基于 lidA 队列研究数据的因果中介分析。
The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study.
机构信息
Department of Occupational Health Science, School of Mechanical Engineering and Safety Engineering, University of Wuppertal, Wuppertal, Germany.
出版信息
PLoS One. 2023 Aug 9;18(8):e0285319. doi: 10.1371/journal.pone.0285319. eCollection 2023.
OBJECTIVES
The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data.
METHODS
Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status.
RESULTS
Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models.
CONCLUSIONS
To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite.
目的
本研究旨在通过应用纵向数据的因果中介分析，探讨工作因素和与健康相关的生活方式对德国老年工人身体健康中教育不平等的贡献。
方法
本研究使用了德国 lidA 研究的数据。共有 2653 名参与者（女性占 53%，男性占 47%），在基线时年龄分别为 46 岁（出生于 1965 年）和 52 岁（出生于 1959 年），并在 2011 年（t0）、2014 年（t1）和 2018 年（t2）进行了随访，评估暴露和结局。采用性别分层因果中介分析和逆概率加权法，将教育对身体健康的总效应分解为自然直接效应（NDE）和自然间接效应（NIE）。将基线健康状况、伴侣状况和工作时间作为第一组中介变量，置于潜在中介变量之前。所有分析均调整了年龄和移民状况。
结果
独立于第一组中介变量，工作因素解释了低教育程度和高教育程度女性之间身体健康教育不平等的 21%，而在比较中度和高度教育程度女性时则为 0%。健康行为的增加分别进一步解释了 26%（低与高教育）和 20%（中与高教育）。在男性中，在排除第一组中介变量后，工作因素解释了低教育程度和高教育程度男性之间身体健康教育不平等的 5%，而在比较中度和高度教育程度男性时则为 6%。健康行为的额外加入分别进一步解释了 24%（低与高教育）和 27%（中与高教育）。
结论
为了减少德国老年工人中身体健康的教育不平等，促进健康行为的干预措施是有希望的。改善工作条件可能是一个重要的前提。
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