Open AccessWorking conditions and health behavior as causes of educational inequalities in self-rated health: an inverse odds weighting approach
Author(s) -
Jolinda L D Schram,
Joost Oude Groeniger,
Merel Schuring,
Karin I. Proper,
Sandra H. van Oostrom,
Suzan J W Robroek,
Alex Burdorf
Publication year - 2020
Publication title -
scandinavian journal of work, environment and health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.621
H-Index - 103
eISSN - 1795-990X
pISSN - 0355-3140
DOI - 10.5271/sjweh.3918
Subject(s) - self rated health , mediation , confidence interval , inequality , medicine , body mass index , demography , gerontology , longitudinal study , odds ratio , psychology , health education , public health , environmental health , mathematics , nursing , mathematical analysis , pathology , sociology , political science , law
Objective Using a novel mediation method that presents unbiased results even in the presence of exposure-mediator interactions, this study estimated the extent to which working conditions and health behaviors contribute to educational inequalities in self-rated health in the workforce. Methods Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 16 countries were selected, aged 50-64 years, in paid employment at baseline and with information on education and self-rated health (N=15 028). Education, health behaviors [including body mass index (BMI)] and working conditions were measured at baseline and self-rated health at baseline and two-year follow-up. Causal mediation analysis with inverse odds weighting was used to estimate the total effect of education on self-rated health, decomposed into a natural direct effect (NDE) and natural indirect effect (NIE). Results Lower educated workers were more likely to perceive their health as poor than higher educated workers [relative risk (RR) 1.48, 95% confidence interval (CI) 1.37-1.60]. They were also more likely to have unfavorable working conditions and unhealthy behaviors, except for alcohol consumption. When all working conditions were included, the remaining NDE was RR 1.30 (95% CI 1.15-1.44). When BMI and health behaviors were included, the remaining NDE was RR 1.40 (95% CI 1.27-1.54). Working conditions explained 38% and health behaviors and BMI explained 16% of educational inequalities in health. Including all mediators explained 64% of educational inequalities in self-rated health. Conclusions Working conditions and health behaviors explain over half of the educational inequalities in self-rated health. To reduce health inequalities, improving working conditions seems to be more important than introducing health promotion programs in the workforce.