Inequalities in self rated health in the 1958 birth cohort: lifetime social circumstances or social mobility?

摘要

Objective—To investigate explanations for social inequalities in health with respect to health related social mobility and cumulative socio-economic circumstances over the first three decades of life. Design—Longitudinal follow up. Setting—Great Britain. Subjects—Data from the 1958 birth cohort study (all children born in England, Wales, and Scotland during 3-9 March 1958) were used, from the original birth survey and from sweeps at 16, 23, and 33 years. Main outcome measures—Subjects' own ratings of their health; social differences in self rated health at age 33. Results—Social mobility varied by health status, with those reporting poor health at age 23 having higher odds of downward mobility than of staying in same social class. Men with poor health were also less likely to be upwardly mobile. Prevalence of poor health at age 33 increased with decreasing social class: from 8.5% in classes Ⅰ and Ⅱ to 17.7% in classes Ⅳ and Ⅴ among men, and from 9.4% to 18.8% among women. These social differences remained significant after adjustment for effects of social mobility. Health inequalities attenuated when adjusted for social class at birth, at age 16, or at 23 or for self rated health at age 23. When adjusted for all these variables simultaneously, social differences in self rated health at age 33 were substantially reduced and no longer significant. Conclusions—Lifetime socioeconomic circumstances accounted for inequalities in self reported health at age 33, while social mobility did not have a major effect on health inequalities.