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competing risks? (Comparing indicators of social status)
a Medizinische
Soziologie OE 5443, Medizinische Hochschule Hannover, 30625 Hannover,
Germany, b Institut für
Medizinische Soziologie, Universität Ulm, Germany
Correspondence to: Dr Geyer
Accepted for publication 29 September 1999
STUDY OBJECTIVE
The
debate on health inequalities has shifted from the consequences of
occupational position, as expressed in the Registrar General's
classification, to consequences of material living conditions. This
change in interest occurred without comparative analyses of different
sources of health inequalities. Thus this study investigated the
relative contribution of "material resources" (income),
"qualification" and "occupational position" for explaining
social differentials in mortality.
DESIGN AND
SETTINGAnalyses were performed with records from
a statutory health insurance in West Germany. The analyses were
performed with data of 84 814 employed men and women between 25 and 65 years of age who were insured between 1987 and 1995 for at least 150 days.
RESULTSThe three
indicators were statistically associated, but not strong enough to
warrant the conclusion that they share the same empirical content. The
relative risk (hazard rate) for income by controlling for occupational
position and gender for the highest as compared with the lowest
category was 1.99 (95% CI 1.66, 2.39). The corresponding relative risk
for income by controlling for qualification and gender was 2.03 (95%
CI 1.68, 2.46). In both multivariate analyses, the effects of
occupational position and qualification were no longer interpretable
because of large confidence intervals. In sum, income related relative
mortality risks were the comparably highest, while qualification and
occupational position were no longer substantial.
CONCLUSIONSThe
results emphasise the present discussion on the consequences of
material living conditions. Income on the one hand and qualification
and occupational position on the other are largely independent.
Mortality related effects of income override those of the other
socioeconomic status indicators. However, seen in a time perspective,
qualification may still have a placement function at least for the
first occupational position.
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