Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data

International Journal for Equity in Health

David Walsh¹  Mel Bartley²  Rich Mitchell³  Srinivasa Vittal Katikireddi³  Ruth Dundas³  Welcome Wami⁴  Duncan Buchanan⁵  Gerry McCartney⁶ 

[1] Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, G40 2QH, Glasgow, UK;Institute of Epidemiology & Health, University College London, 1-19 Torrington Place, WC1E 7HB, London, UK;MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, G2 3AX, Glasgow, UK;MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, G2 3AX, Glasgow, UK;Present Address: Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP, Amsterdam, Netherlands;Public Health Scotland, Gyle Square, 1 South Gyle Crescent, EH12 9EB, Edinburgh, UK;Public Health Scotland, Meridian Court, 5 Cadogan Street, G2 6QE, Glasgow, UK;

关键词: Health inequalities;    Self-rated health;    SF-36;    Social class theory;    Socio-economic position;   

DOI  :  10.1186/s12939-020-01302-4

来源: Springer

【 摘 要 】

BackgroundSocial class is frequently used as a means of ranking the population to expose inequalities in health, but less often as a means of understanding the social processes of causation. We explored how effectively different social class mechanisms could be measured by longitudinal cohort data and whether those measures were able to explain health outcomes.MethodsUsing a theoretically informed approach, we sought to map variables within the National Child Development Study (NCDS) to five different social class mechanisms: social background and early life circumstances; habitus and distinction; exploitation and domination; location within market relations; and power relations. Associations between the SF-36 physical, emotional and general health outcomes at age 50 years and the social class measures within NCDS were then assessed through separate multiple linear regression models. R2 values were used to quantify the proportion of variance in outcomes explained by the independent variables.ResultsWe were able to map the NCDS variables to the each of the social class mechanisms except ‘Power relations’. However, the success of the mapping varied across mechanisms. Furthermore, although relevant associations between exposures and outcomes were observed, the mapped NCDS variables explained little of the variation in health outcomes: for example, for physical functioning, the R2 values ranged from 0.04 to 0.10 across the four mechanisms we could map.ConclusionsThis study has demonstrated both the potential and the limitations of available cohort studies in measuring aspects of social class theory. The relatively small amount of variation explained in the outcome variables in this study suggests that these are imperfect measures of the different social class mechanisms. However, the study lays an important foundation for further research to understand the complex interactions, at various life stages, between different aspects of social class and subsequent health outcomes.

【 授权许可】

CC BY