Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice

作者：Siegfried Geyer, Örjan Hemström, Richard Peter, Denny Vågerö · 发表于：Journal of Epidemiology & Community Health · 年份：2006 · DOI：10.1136/jech.2005.041319 · 被引用次数：698 · 研究领域：Health disparities and outcomes、Employment and Welfare Studies、Intergenerational and Educational Inequality Studies

STUDY OBJECTIVE: Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. DESIGN: Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. SETTING AND PARTICIPANTS: Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). MAIN RESULTS: Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a m...