Hart C L, Smith G D, Blane D
Department of Public Health, University of Glasgow, UK.
Soc Sci Med. 1998 Oct;47(8):1121-30. doi: 10.1016/s0277-9536(98)00061-6.
The objective of this prospective cohort study was to determine the contribution of changes in social class within and between generations to mortality risk and to socioeconomic differentials in mortality. In 27 workplaces in the west of Scotland. 5567 men aged 35-64 years when screened, provided information on their father's occupation, their own first occupation and their occupation at screening. Mortality risk, from broad causes of death by intergenerational and intragenerational social mobility groups, was measured after 21 years. For all or some of the 3 routes of mobility (childhood to screening, labour market entry to screening and childhood to labour market entry), increasing values were seen across the 4 groups (stable non manual, upwardly mobile, downwardly mobile and stable manual) for diastolic blood pressure, body mass index, current smoking, early school leaving, angina, bronchitis, severe chest pain, and proportion living in deprived areas. Decreasing values were seen for serum cholesterol, height, FEV1, exercise, never and ex-smokers, wine drinkers and car users. For mobility between childhood and screening and between childhood and labour market entry, mortality risk was highest for the stable manual group and lowest for the stable non manual group for all cause, cardiovascular disease and other causes of death. The upwardly and downwardly mobile groups had intermediate risks. For cancer mortality, the stable manual group had the highest risk with the other groups having lower and similar risks. For mobility between labour market entry and screening, the highest risk was for the downwardly mobile group for all cause and cardiovascular mortality. For cancer mortality, the risk was higher for men in manual social classes at all occasions. Adjustment for risk factors attenuated but could not completely explain the differentials in mortality risk. Overall, major differences in mortality risk were seen between the stable non manual and the stable manual groups, to which social mobility does not contribute. With the exception of the small intragenerationally downwardly mobile group there was little evidence that social mobility itself was associated with mortality outcomes different from those expected on the basis of lifetime socioeconomic experience. This is consistent with the suggestion that the main influence of socioeconomic position on mortality risk is an accumulative one, acting across the lifecourse.
这项前瞻性队列研究的目的是确定代内和代际社会阶层变化对死亡风险以及死亡率社会经济差异的影响。在苏格兰西部的27个工作场所，5567名年龄在35 - 64岁之间接受筛查的男性提供了有关其父亲职业、自己的第一份职业以及筛查时职业的信息。21年后，对代际和代内社会流动群体的广泛死因的死亡风险进行了测量。对于全部或部分三种流动途径（童年到筛查、劳动力市场进入到筛查以及童年到劳动力市场进入），在舒张血压、体重指数、当前吸烟状况、过早辍学、心绞痛、支气管炎、严重胸痛以及生活在贫困地区的比例方面，4个群体（稳定非体力劳动者、向上流动者、向下流动者和稳定体力劳动者）的数值均呈上升趋势。血清胆固醇、身高、第一秒用力呼气量、运动情况、从不吸烟者和已戒烟者、饮酒者以及汽车使用者的数值则呈下降趋势。对于童年到筛查以及童年到劳动力市场进入之间的流动，稳定体力劳动者群体的全因、心血管疾病和其他死因的死亡风险最高，稳定非体力劳动者群体的死亡风险最低。向上流动和向下流动群体的风险处于中间水平。对于癌症死亡率，稳定体力劳动者群体的风险最高，其他群体的风险较低且相似。对于劳动力市场进入到筛查之间的流动，向下流动群体的全因和心血管死亡率风险最高。对于癌症死亡率，在所有情况下，体力社会阶层男性的风险都更高。对风险因素进行调整后，差异有所减弱，但无法完全解释死亡风险的差异。总体而言，稳定非体力劳动者和稳定体力劳动者群体之间在死亡风险上存在重大差异，社会流动对此并无影响。除了代内小部分向下流动的群体外，几乎没有证据表明社会流动本身与基于一生社会经济经历预期不同的死亡结果相关。这与社会经济地位对死亡风险的主要影响是累积性的、贯穿生命历程这一观点相一致。
