House J S, Lepkowski J M, Kinney A M, Mero R P, Kessler R C, Herzog A R
Institute for Social Research, University of Michigan, Ann Arbor 48106-1248.
J Health Soc Behav. 1994 Sep;35(3):213-34.
The way health varies with age is importantly stratified by socioeconomic status (SES)--specifically, education and income. Prior theory and cross-sectional data suggest that among higher SES persons the onset of health problems is usually postponed until rather late in life, while health declines are prevalent in lower SES groups by middle age. Thus, SES differences in health are small in early adulthood, but increase with age until relatively late in life, when they diminish due to selection or greater equalization of health risks and protections. The present paper strengthens our causal and interpretive understanding of these phenomena by showing: (1) that results previously reported for indices of SES hold separately for education and income; (2) that the interaction between age and SES (i.e., education or income) in predicting health can be substantially explained by the greater exposure of lower SES persons to a wide range of psychosocial risk factors to health, especially in middle and early old age, and, to a lesser degree, the greater impact of these risk factors on health with age; and (3) that results (1) and (2) generally hold in short-term longitudinal as well as in cross-sectional data. Implications for science and policy in the areas of aging, health, and social stratification are discussed.
健康随年龄变化的方式在很大程度上因社会经济地位（SES）而分层，具体而言，是受教育程度和收入的影响。先前的理论和横断面数据表明，在社会经济地位较高的人群中，健康问题通常会推迟到生命后期才出现，而在社会经济地位较低的群体中，中年时健康状况下降则很普遍。因此，成年早期健康方面的社会经济地位差异较小，但随着年龄增长而增大，直到生命后期，由于选择因素或健康风险与保护的更趋均等，这种差异才会减小。本文通过以下几点加强了我们对这些现象的因果关系和解释性理解：（1）先前报告的社会经济地位指标结果分别适用于受教育程度和收入；（2）年龄与社会经济地位（即受教育程度或收入）在预测健康方面的相互作用，很大程度上可以解释为社会经济地位较低的人群更多地暴露于广泛的健康心理社会风险因素中，尤其是在中老年早期，并且在较小程度上，这些风险因素对健康的影响会随着年龄增长而增大；（3）结果（1）和（2）在短期纵向数据以及横断面数据中通常都成立。本文还讨论了这些结果对老龄化、健康和社会分层领域的科学及政策的影响。
