International Journal of Epidemiology, Vol 26, 592-600, Copyright © 1997 by International Epidemiological Association
K Stronks, H van de Mheen, J van den Bos and JP Mackenbach
BACKGROUND: The aim of the study was to test the hypothesis that the
relatively strong association between income and health compared to that
between education/occupation and health, can partly be interpreted in terms
of an association between employment status and health. METHODS: Health
indicators used were the prevalence of one or more chronic conditions, and
perceived general health. Data were generated from a postal survey, part of
the baseline data collection of a Dutch prospective cohort study on
socioeconomic inequalities in health. RESULTS: After controlling for
differences in other socioeconomic indicators, the association between
income and health was found to be stronger than that between occupation or
education and health. Most of the difference in strength was found to be
due to employment status, especially among men. Controlling for employment
status, and controlling for the distribution of those with a long-term work
disability in particular, reduced the risks of lower income groups, whereas
the risks of lower educational and occupational groups hardly changed.
CONCLUSIONS: These results suggest that the relatively strong association
between income and health can for a large part be interpreted in terms of
an interrelationship between employment status, income and health. More
specifically, it is largely due to the concentration of the long-term
disabled in lower income groups. This indicates the importance of the
selection mechanism, as these groups are excluded from paid employment
because of their health status, leading to a lowering of income. However,
income was still found to be related to perceived general health after
controlling for employment status especially among women. This suggests
that an explanation in terms of an effect of material factors on health may
also be important.
ARTICLES
The interrelationship between income, health and employment status
Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
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