Health Behavior vs the Stress of Low Socioeconomic Status and Health Outcomes

Dunn, James R.

doi:10.1001/jama.2010.332

Cited by 47 publications

(29 citation statements)

References 13 publications

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“…We found that behavioural factors play an important role in contributing to SES mortality disparities, but other dominant mechanisms are likely at play. The production of SES health disparities are varied encompassing complex interplays of behavioural factors, healthcare access, psychosocial factors and occupational and environmental hazards,41 42 the relative contributions of which likely vary across time and place. Each of these factors should be considered in a comprehensive set of policies aimed at improving population health and reducing disparities.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of health behaviours and socioeconomic differences in mortality in the USA

Mehta

House

Elliott

2015

J Epidemiol Community Health

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Background To measure the explanatory role of behavioral factors to educational and income disparities in mortality among U.S. adults (ages 25+). Methods Data were from 4 waves of the American Changing Lives Study (N=3,617). There were 1,832 deaths between 1986 and 2011. Smoking, physical activity, alcohol, and BMI were examined. Results Those with 0–11 years of schooling had an 88% (95% CI: 48%, 139%) increased risk of dying compared to those with 16+ years of schooling. Behavioral factors explained 41% (95% CI: 26%, 55%) and 50% (95% CI: 30%, 70%) of this excess in models that treated behavioral factors as fixed (single point in time) and time-varying (repeated), respectively. The lowest income group (bottom 20th percentile) had a 209% (95% CI: 172%, 256%) increased risk of dying relative to the highest income group (top 40th percentile). Behavioral factors explained 24% (fixed, 95% CI: 13%, 35%) and 39% (repeated, 95% CI: 22%, 56%) of this difference. Analyses of deaths by causes indicated that behavioral factors were more consequential to disparities in cardiovascular mortality, explaining up to 83% of educational differences, compared to cancer and other death causes. Conclusion Behavioral factors are one of a number of factors which explain socioeconomic mortality disparities, but their estimated explanatory role depends on a number of parameters including the SES measure examined, the cause of death, and age. In this nationally representative sample, findings based on repeated measures did not warrant a reevaluation of earlier estimates.

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Section: Discussionmentioning

confidence: 99%

Dynamics of health behaviours and socioeconomic differences in mortality in the USA

Mehta

House

Elliott

2015

J Epidemiol Community Health

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“…The extent to which such behaviours explain the persistent inverse social gradient in mortality is a fundamental health policy question 9. An analysis of mortality in the Whitehall II cohort that utilised repeated measures of key risk behaviours over 24 years of follow-up showed that a large part of the socioeconomic mortality gradient could be explained in this way 10.…”

Section: Introductionmentioning

confidence: 99%

“…As the article and accompanying editorial noted,9 10 socioeconomic inequalities in health are not reducible to health behaviours. The underlying reasons for the common social pattern in health behaviour—the causes of the causes—need to be investigated so that health inequities can be understood with a view to their reduction 16.…”

Section: Introductionmentioning

confidence: 99%

Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort

Giesinger¹,

Goldblatt

Howden‐Chapman

et al. 2013

J Epidemiol Community Health

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BackgroundA large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk.MethodsAnalysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66.ResultsMortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model.ConclusionsEarly life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.

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“…These are particularly noteworthy given that well-being was improved significantly in a uniquely challenged, sociodemographically disadvantaged workforce-a population that has been characterized in prior research as having more prevalent well-being risks, chronic illness, and barriers to change than other populations. [23][24][25][26] It is important to note that this intervention did not target the work environment or components of basic access (affordable shelter and health care), and the domain of work environment did not show any evidence of significant improvement. In contrast, personal barriers to presenteeism were reduced, as measured through the WBA-PP.…”

Section: Discussionmentioning

confidence: 99%

Well-Being, Health, and Productivity Improvement After an Employee Well-Being Intervention in Large Retail Distribution Centers

Rajaratnam

Sears

Shi

et al. 2014

Journal of Occupational &Amp; Environmental Medicine

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Health Behavior vs the Stress of Low Socioeconomic Status and Health Outcomes

Cited by 47 publications

References 13 publications

Dynamics of health behaviours and socioeconomic differences in mortality in the USA

Dynamics of health behaviours and socioeconomic differences in mortality in the USA

Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort

Well-Being, Health, and Productivity Improvement After an Employee Well-Being Intervention in Large Retail Distribution Centers

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