Multiple measures of socio-economic position and psychosocial health: proximal and distal measures.

BACKGROUND The aim of this paper is to compare three models for exploring the links between different measures of adult socioeconomic position (SEP)-education, occupation, income-and psychosocial health. Model I is a basic univariate regression model with psychosocial health as the outcome and a measure of SEP as the predictor. Model II is a multiple regression model with psychosocial health as the outcome with all three measures of SEP allocated the same temporal position as predictors. Model III treats education, a distal measure of SEP, as antecedent to the proximal measures of SEP in the prediction equations linking SEP to health. METHODS Participants were drawn from the Whitehall II study, a prospective cohort study of British civil servants. Data analysed here are from Phase 5 (1997-1999) of data collection, 7830 individuals in all. The measures of SEP and psychosocial health were assessed via a self-administered questionnaire. RESULTS The three models can lead to completely different conclusions. Model III, our preferred model, shows education to have a stronger indirect effect on psychosocial health when compared to its direct effect. The indirect effect is due to the effect of education on proximal measures of social position, occupation, and income in this case. CONCLUSIONS Results reported here support the hypothesis that a comparison of the relative importance of the different measures of social position in predicting health is meaningless if the causal relationships among these measures are not accounted for.

[1]  M. Wadsworth,et al.  Accumulation of factors influencing respiratory illness in members of a national birth cohort and their offspring. , 1992, Journal of epidemiology and community health.

[2]  M. Marmot.  Aetiology of coronary heart disease , 2001, BMJ : British Medical Journal.

[3]  P. Whincup,et al.  Influence of fathers' social class on cardiovascular disease in middle-aged men , 1996, The Lancet.

[4]  D Lester,et al.  The measurement of pessimism: the hopelessness scale. , 1974, Journal of consulting and clinical psychology.

[5]  S. Arber,et al.  Gender differences in health in later life: the new paradox? , 1999, Social science & medicine.

[6]  C. Power,et al.  Inequalities in self rated health in the 1958 birth cohort: lifetime social circumstances or social mobility? , 1996, BMJ.

[7]  M. Blaxter.  Health and lifestyles , 1990 .

[8]  David R. Williams,et al.  Measuring social class in US public health research: concepts, methodologies, and guidelines. , 1997, Annual review of public health.

[9]  R. Weitkunat,et al.  Exploratory causal modeling in epidemiology: are all factors created equal? , 2002, Journal of clinical epidemiology.

[10]  E. Ziegel,et al.  Basic Principles of Structural Equation Modelling , 1996 .

[11]  J. Salonen,et al.  Socioeconomic conditions in childhood and ischaemic heart disease during middle age. , 1990, BMJ.

[12]  R. Peter,et al.  Income, occupational position, qualification and health inequalities—competing risks? (Comparing indicators of social status) , 2000, Journal of epidemiology and community health.

[13]  Chris Power,et al.  Inequalities in self-rated health: explanations from different stages of life , 1998, The Lancet.

[14]  G. Watt,et al.  Education and occupational social class: which is the more important indicator of mortality risk? , 1998, Journal of epidemiology and community health.

[15]  J. Fox.  Health inequalities in European countries , 1989 .

[16]  S. Arber,et al.  Comparing inequalities in women's and men's health: Britain in the 1990s. , 1997, Social science & medicine.

[17]  Catherine E. Ross,et al.  The links between education and health. , 1995 .

[18]  James L. Arbuckle,et al.  Full Information Estimation in the Presence of Incomplete Data , 1996 .

[19]  Gower Street,et al.  Health inequalities among British civil servants: the Whitehall II study , 1991, The Lancet.

[20]  B. Muthén.  BEYOND SEM: GENERAL LATENT VARIABLE MODELING , 2002 .

[21]  J. Hair.  Multivariate data analysis , 1972 .

[22]  S. Fortmann,et al.  Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. , 1992, American journal of public health.

[23]  E. Dahl.  Social inequalities in ill‐health: the significance of occupational status, education and income‐results from a Norwegian survey , 1994 .

[24]  N. Krieger,et al.  Social Class: The Missing Link in U.S. Health Data , 1994, International journal of health services : planning, administration, evaluation.

[25]  J. Salonen,et al.  Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. , 1997, Social science & medicine.

[26]  Iris Pigeot,et al.  A comparative analysis of graphical interaction and logistic regression modelling: Self-care and coping with a chronic illness in later life , 2002 .

[27]  Walter W. Cook,et al.  Proposed hostility and Pharisaic-virtue scales for the MMPI. , 1954 .

[28]  M. Marmot,et al.  Multiple measures of socioeconomic health and psychosocial health: proximal and distal effects , 2002 .

[29]  A. J. Fox,et al.  Health in Childhood and Social Inequalities in Health in Young Adults , 1990 .

[30]  C. Hart,et al.  Lifetime socioeconomic position and mortality: prospective observational study , 1997, BMJ.

[31]  D. Goldberg.  The detection of psychiatric illness by questionnaire : a technique for the identification and assessment of non-psychotic psychiatric illness , 1972 .

[32]  D. Vågerö,et al.  Effect of social class in childhood and adulthood on adult mortality , 1994, The Lancet.

[33]  R. Fitzpatrick,et al.  Dimensions of social inequality in the health of women in England: occupational, material and behavioural pathways. , 2001, Social science & medicine.

[34]  Y. Ben-Shlomo,et al.  Deprivation in infancy or in adult life: which is more important for mortality risk? , 1991, The Lancet.

[35]  R. Fitzpatrick,et al.  Understanding social variation in cardiovascular risk factors in women and men: the advantage of theoretically based measures. , 1999, Social science & medicine.

[36]  Y. Ben-Shlomo,et al.  A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives , 2002 .

[37]  George A. Marcoulides,et al.  Interaction and Nonlinear Effects in Structural Equation Modeling , 1998 .

[38]  S. Hershberger,et al.  A Simple Rule for Generating Equivalent Models in Covariance Structure Modeling. , 1990, Multivariate behavioral research.

[39]  O. D. Duncan.  How Destination Depends on Origin in the Occupational Mobility Table , 1979, American Journal of Sociology.

[40]  R. Fitzpatrick,et al.  Comparing health inequality in men and women: prospective study of mortality 1986-96 , 2000, BMJ : British Medical Journal.

[41]  O. Vassend,et al.  The Role of Negative Affectivity in Self assessment of Health , 1999, Journal of health psychology.

[42]  M. Marmot,et al.  Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study , 2001, Journal of epidemiology and community health.