Qi Yuwei, Reijneveld Sijmen A, Almansa Josué, Brouwer Sandra, Vrooman J Cok
University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, the Netherlands.
Utrecht University, Department of Sociology/ICS, Utrecht, the Netherlands.
SSM Popul Health. 2024 Feb 29;25:101644. doi: 10.1016/j.ssmph.2024.101644. eCollection 2024 Mar.
Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital.
We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. was measured through education, income, occupation, home equity, and liquid assets. was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; by lifestyle, digital skills, and mastery of English, and by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression.
In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex.
The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.
不同的死亡风险与广泛的社会因素相关，不仅包括教育和收入，还包括其他经济和非经济资源。本研究的目的是评估死亡风险与四种类型资源的关联：经济、社会、文化和人力资本。
我们使用了来自荷兰差异调查的2952名参与者的数据以及荷兰统计局2014年至2021年期间的年度死亡率数据。经济资本通过教育、收入、职业、房屋净值和流动资产来衡量。社会资本通过社会关系的强度、核心讨论网络的规模以及与有资源地位的人的联系来衡量；文化资本通过生活方式、数字技能和英语掌握程度来衡量，而人力资本通过自我评估健康状况、爬楼梯障碍、自信心、自我形象、外貌和体重指数来衡量。为了适应每种资本都来自多个指标这一事实，我们使用了偏最小二乘（PLS）Cox回归。
在多元回归中，较高的经济、文化和人力资本与较低的死亡率相关（风险比分别为0.77；95%置信区间[CI，0.65至0.90]、0.77[0.64 - 0.93]和0.80；[0.70 - 0.92]），并对所有资本指标和性别进行了调整。
更多的经济、文化和人力资本与较低的死亡率相关这一发现，为一种方法提供了实证支持，该方法使用了广泛的资本指标——迄今为止在流行病学研究中很少同时纳入——以理解不同的死亡风险。通过整合社会学概念、队列数据和流行病学研究方法，我们的研究强调了进一步研究不同形式资源在塑造健康不平等方面相互作用的必要性。在设计公共卫生干预措施时，我们主张采用基于多维度资本的框架来解决死亡率方面的社会差异。
