Objectives : Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupati...
Objectives : Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupation-based SEP, income and wealth, area SEP, life-course SEP, and SEP indicators for women, elderly and youth. Methods and results : This report provides a brief theoretical background and discusses the measurement, interpretation issues, advantages and limitations associated with the use of each SEP indicator. We also describe some problems that arise when selecting SEP indicators and highlight the indicators that appear to be appropriate for health inequality research. Some practical information for use in health inequality research in South Korea is also presented. Conclusions : Investigation into the associations between various SEP indicators and health outcomes can provide a more complete understanding of mechanisms between SEP and health. The relationship between specific SEP indicators and specific health outcomes can vary by country due to the differences in the historical, socioeconomic, and cultural contexts of the SEP indicators.
Objectives : Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupation-based SEP, income and wealth, area SEP, life-course SEP, and SEP indicators for women, elderly and youth. Methods and results : This report provides a brief theoretical background and discusses the measurement, interpretation issues, advantages and limitations associated with the use of each SEP indicator. We also describe some problems that arise when selecting SEP indicators and highlight the indicators that appear to be appropriate for health inequality research. Some practical information for use in health inequality research in South Korea is also presented. Conclusions : Investigation into the associations between various SEP indicators and health outcomes can provide a more complete understanding of mechanisms between SEP and health. The relationship between specific SEP indicators and specific health outcomes can vary by country due to the differences in the historical, socioeconomic, and cultural contexts of the SEP indicators.
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문제 정의
이 글은 건강 불평등 연구 또는 사회 역 학연구의 핵심 개념인 사회경제적 위치 지표의 이론적 배경, 변수 측정 방법, 해당 지표를 사용한 연구 결과 해석, 개별 사회경제적 위치 지표의 장단점 등을 기술하는것을 목적으로 삼는다. 또 사회경제적 위치 지표 선택과 활용의 몇 가지 이슈들도다룰 것이다.
이는 우리나라의 최근 연구에서도 유사한데, Kim등 [52]의 연구에 따르면, 검토한총8개의 지역 지표중에서 주택 보유율과 실업률은 주성분 분석에서 서로다른 요소로 구분되었다. 이러한 연구 결과들은, 한국이나 일본과 같이 도시-농촌간의 주거문화 및 노동인구 구성 의 양상이 서구와 다른 나라에서 지역단위 박탈지표를 어떻게 활용하여야 할 것인가에대한 연구 과제를 제기 한다.
따라서 지 역간 건강격차는 A와 C의 관계 에 의 해 발생 한다고 볼 수 있다. 지역의 사회경제적 위치를 연구하는첫째 목적은 A와 C의 관계의 크기와 발생원인을 조사하여 지역간 사회경제적 차이로 인한 건강 격차(X) 해소방안을 모색하는 것이다. 그뿐 아니라, A와 C는 개인의사회경제적 위치가 개인의 건강을 결정하는 하나의 경로를 형성한다.
또 사회경제적 위치 지표 선택과 활용의 몇 가지 이슈들도다룰 것이다. 특히 이 글에서는 한국의 건강 불평등 연구에서 사회경제적 위치 지표의 활용 사례 및 활용 방안을 다룬다.
가설 설정
1. 가장 좋은 사회경제적 위치 지표가있는가?
있다. 교육수준을 연속변수로 측정 한경우, 교육 받은 개별 1년이 개인이 획득한사회경제적 위치에 동일한 영향을 미친다고 가정 한다. 반면, 학력 같은 범주형 변수로 교육수준을 측정할 때에는 특정 학력 (예: 고졸, 대졸 등)이 개인의 사회경제적위치에 더 중요한 영향을 미치고 특정 학력 안에서의 교육연수 차이는 상대적으로덜 중요하다고 전제한다 [8], 교육수준을사회경제적 위치 지표로 사용한 대부분의우리나라 건강 불평등 연구들의 경우, 교육연수라는 연속형 변수보다는 학력이라는 범주형 변수를 사용하여왔다.
그러므로 건강에 대한 직업의 영향은 소득 같은 물질적 자원이 건강에 미치는 효과의 하나로 이해할 수 있다. 둘째, 직업은개인의 사회적 지위를 반영한다. 즉, 어떤직업들은 양질의 의료와 교육, 주거에 대한 접근권이 보장된다는 점을 반영한다.
성능/효과
이는 직업이 심리사회적 기전을통해 건강에 영향을 미칠 수 있음을 시사한다. 넷째, 특정 직업은 건강에 해로운 물리적 . 화학적 .
따라서 교육이나 소득 수준구분 시, 때에 따라그 절대적 기준이 성별로 달리 설정될 필요가 있으며, 결과의 해석에도 이러한 성별분리 현상을 충분히고려하여야 한다. 둘째, 여성 내부에서도취업여성과 전업주부 간 사회경제적 위치의 분포 차이나, 결과에 영향을 미치는 기전 등이 다를 수 있음에 유의 해야 한다. 셋째, 새로 개발된 사회경제적 위치 지표가여성의 현실을 더욱 적합하게 반영하기위한 문제의식 에서 출발하였으나, 그 타당성과 유용성을 검증하기 위해서는 남성에게도 동일하게 적용해 볼 필요가 있다.
즉, 어떤직업들은 양질의 의료와 교육, 주거에 대한 접근권이 보장된다는 점을 반영한다. 셋째, 직업은 사회적 연결망, 직무스트레스, 직무 통제와 직무에서 의 자율성을 반영한다. 이는 직업이 심리사회적 기전을통해 건강에 영향을 미칠 수 있음을 시사한다.
한다. 첫째, 교육수준은 줄생 코호트에 따라 다른 의미를 지닌다. 예를 들어연령이 높은 코호트의 평균 교육수준은낮다.
해석은 다양하다. 첫째, 부모나 자신의 직업은 소득과 매우 깊은 관계가 있다. 그러므로 건강에 대한 직업의 영향은 소득 같은 물질적 자원이 건강에 미치는 효과의 하나로 이해할 수 있다.
첫째, 여성과 남성은 주요 사회경제적 위치 지표인 교육수준, 소득, 직업의 분포에서 상당한 차이를 보인다. 여성은 일반적 으로 남성 에 비 해 교육수준과 소득이낮으며, 근무하는 업종이 다를 뿐만 아니라 동일 업종에 근무한다 하더라도 남성과는 다른 직무에 다른 노동조건으로 근무하게 된다.
후속연구
둘째, 여성 내부에서도취업여성과 전업주부 간 사회경제적 위치의 분포 차이나, 결과에 영향을 미치는 기전 등이 다를 수 있음에 유의 해야 한다. 셋째, 새로 개발된 사회경제적 위치 지표가여성의 현실을 더욱 적합하게 반영하기위한 문제의식 에서 출발하였으나, 그 타당성과 유용성을 검증하기 위해서는 남성에게도 동일하게 적용해 볼 필요가 있다.
참고문헌 (100)
Lynch JW, Kaplan GA. Socioeconomic position. In: Berkman LF, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000. p. 13-35
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S. Socioeconomic status in health research: one size does not fit all. JAMA 2005; 294(22): 2879-2888
Choi BH, Roh YH, Yoon BS, Shin HW, Kim MH, Kim CY. Measuring inequity in health care and policy proposals in Korea. Korea Institute for Health and Social Affairs; 2004. Report No.: 2004-09 (Korean)
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006; 60(1): 7-12
Davey Smith G, Hart C, Hole D, MacKinnon P, Gillis C, Watt G, Blane D, Hawthorne V. Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health 1998; 52(3): 153-160
White IR, Blane D, Morris JN, Mourouga P. Educational attainment, deprivation-affluence and self reported health in Britain: A cross sectional study. J Epidemiol Community Health 1999; 53(9): 535-541
Morris JN, Blane DB, White IR. Levels of mortality, education, and social conditions in the 107 local education authority areas of England. J Epidemiol Community Health 1996; 50(1): 15-17
Khang YH, Kim HR. Explaining socioeconomic inequality in mortality among South Koreans: An examination of multiple pathways in a nationally representative longitudinal study. Int J Epidemiol 2005; 34(3): 630-637
Khang YH. Relationship between childhood socio-economic position and mortality risk in adult males of the Korea Labour and Income Panel Study (KLIPS). Public Health 2006; 120(8): 724-731
Kim HR, Khang YH. Reliability of education and occupational class: A comparison of health survey and death certificate data. J Prev Med Public Health 2005; 38(4): 443-448 (Korean)
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 2). J Epidemiol Community Health 2006; 60(2): 95-101
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annu Rev Public Health 1997; 18: 341-378
Kim IH, Paek DM, Cho SI. Does non-standard work affect health? J Prev Med Public Health 2005; 38(3): 337-344 (Korean)
Kim IH, Muntaner C, Khang YH, Paek D, Cho SI. The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Soc Sci Med 2006; 63(3): 566-574
Bartley M. Health Inequality: An Introduction to Theories, Concepts and Methods. Cambridge: Polity Press; 2004
Bartley M, Carpenter L, Dunnell K, Fitzpatrick R. Measuring inequalities in health: An analysis of mortality patterns using two social classifications. Sociol Health Illn 1996; 18(4): 455-474
Hong DS, Kim BJ, Cho DG. Occupational Structure in Korea. Seoul National University Press; 1999 (Korean)
Breen R. Foundations of a neo-Weberian class analysis. In: Wright EO, editor. Approaches to Class Analysis. Cambridge: Cambridge University Press; 2005. p. 36-43
Son M. The relationships of occupational class, educational level and deprivation with mortality in Korea. Korean J Prev Med 2002; 35(1): 76-82 (Korean)
Khang YH, Lee SI, Lee MS, Jo MW. Socioeconomic mortality inequalities in Korea Labor & Income Panel Study. Korean J Health Policy Adm 2004; 14(4): 1-20 (Korean)
Kim CS, Yun SC, Kim HR, Khang YH. A multilevel study on the relationship between the residential distribution of high class (power elites) and smoking in Seoul. J Prey Med Public Health 2006; 39(1): 30-38 (Korean)
Son M, Armstrong B, Choi JM, Yoon TY. Relation of occupational class and education with mortality in Korea. J Epidemiol Community Health 2002; 56(10): 798-799
Kim HR, Kim YS. A study of differences in chronic diseases prevalence between socioeconomic classes. J Korean Soc Health Stat 2003; 28(2): 56-66 (Korean)
Yoon TH. The relationship between social class distribution and mortality. Korean J Health Policy Adm 2003; 13(4): 99-114 (Korean)
Lee SY, Hong SC. Difference in incidence rate of low birth weight among the parental social strata in Korea. Health Soc Sci 2003; 13: 61-79 (Korean)
Cho HJ, Khang YH, Yun SC. Occupational differentials in cigarette smoking in South Korea: Findings from the 2003 Social Statistics Survey. J Prev Med Public Health 2006; 39(4): 365-370 (Korean)
Kunst AE, Groenhof F, Mackenbach JP, Health EW. Occupational class and cause specific mortality in middle aged men in 11 European countries: Comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ 1998; 316(7145): 1636-1642
Wohlfarth T, van den Brink W. Social class and substance use disorders: The value of social class as distinct from socioeconomic status. Soc Sci Med 1998; 47(1): 51-58
Muntaner C, Borrell C, Benach J, Pasarin MI, Fernandez E. The associations of social class and social stratification with patterns of general and mental health in a Spanish population. Int J Epidemiol 2003; 32(6): 950-958
Daly MC, Duncan GJ, McDonough P, Williams DR. Optimal indicators of socioeconomic status for health research. Am J Public Health 2002; 92(7): 1151-1157
Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet 1997; 349(9066): 1655-1659
Parle CY, Kim JW, Kim TW. The change of poverty and income inequality level during economic crisis and counter policies in Korea. Korea Institute for Health and Social Affairs; 1999. Report No.: 99-07 (Korean)
Jeong JH, Hwang DS, Lee BH, Choi GS. Reports on Income Inequality and Poverty, and Policy Suggestions. Korea Labor Institute; 2002 (Korean)
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G, Lynch J. Indicators of Socioeconomic Position. In: Oakes JM, Kaufman JS, editors. Methods in Social Epidemiology. San Francisco: Jossey-Bass; 2006. p. 47-85
Turrell G. Income non-reporting: Implications for health inequalities research. J Epidemiol Community Health 2000; 54(3): 207-214
Kim HR, Khang YH, Park EJ, Choi JS, Lee YH, Kim YS. Socioeconomic, Behavioral, Nutritional, and Biological Determinants of Morbidity, Mortality, and Medical Utilization in South Korea: Analysis of Korea National Health and Nutrition Examination Survey (KNHANES) Linked Data. Korea Institute for Health and Social Affairs; 2006. Report No.: 2006-04 (Korean)
Townsend P, Phillimore P, Beattie A. Health and Deprivation: Inequality and the North. London: Routledge; 1988
Carstairs V, Morris R. Deprivation: Explaining differences in mortality between Scotland and England and Wales. BMJ 1989; 299(6704): 886-889
Jarman B. Underprivileged areas: Validation and distribution of scores. BMJ 1984; 289(6458): 1587-1592
Fukuda Y, Nakamura K, Takano T. Municipal socioeconomic status and mortality in Japan: Sex and age differences, and trends in 1973-1998. Soc Sci Med 2004; 59(12): 2435-2445
Kim MH, Subramanian SV, Kawachi I, Kim CY. Association between childhood fatal injuries and socioeconomic position at individual and area levels: A multilevel study. J Epidemiol Community Health 2007; 61(2): 135-140
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US). J Epidemiol Community Health 2003; 57(3): 186-199
Kim MH. A multilevel analysis on the association between socioeconomic factors and the metabolic syndrome dissertation. Korea: Hanyang Univ; 2002 (Korean)
Jeong BG, Jung KY, Kim JY, Moon OR, Lee YH, Hong YS, Yoon TH. The relationship between regional material deprivation and the standardized mortality ratio of the community residents aged 15-64 in Korea. J Prev Med Public Health 2006; 39(1): 46-52 (Korean)
Kuh D, Ben-Shlomo Y, editors. A Life Course Approach to Chronic Disease Epidemiology. 2nd ed. Oxford: Oxford University; 2003
Davey Smith G, editor. Health Inequalities: Lifecourse Approaches. Bristol: Policy Press; 2003
Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman WP 3rd, Herderick EE, Comhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA 1999; 281(8): 727-735
Berney LR, Blane DB. Collecting retrospective data: Accuracy of recall after 50 years judged against historical records. Soc Sci Med 1997; 45(10): 1519-1525
Krieger N, Okamoto A, Selby JV. Adult female twins' recall of childhood social class and father's education: A validation study for public health research. Am J Epidemiol 1998; 147(7): 704-708
Kauhanen L, Lakka HM, Lynch JW, Kauhanen J. Social disadvantages in childhood and risk of all-cause death and cardiovascular disease in later life: A comparison of historical and retrospective childhood information. Int J Epidemiol 2006; 35(4): 962-968
Galobardes B, Lynch JW, Davey Smith G. Childhood socioeconomic circumstances and cause-specific mortality in adulthood: Systematic review and interpretation. Epidemiol Rev 2004; 26(1): 7-21
Galobardes B, Davey Smith G, Lynch JW. Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Ann Epidemiol 2006; 16(2): 91-104
Song YM, Davey Smith G, Sung J. Adult height and cause-specific mortality: A large prospective study of South Korean men. Am J Epidemiol 2003; 158(5): 479-485
Davey Smith G, Leary S, Ness S; The ALSPAC Study Team. Could dehydration in infancy lead to high blood pressure? J Epidemiol Community Health 2006; 60(2): 142-143
Lawlor DA, Smith GD, Mitchell R, Ebrahim S. Adult blood pressure and climate conditions in infancy: A test of the hypothesis that dehydration in infancy is associated with higher adult blood pressure. Am J Epidemiol 2006; 163(7): 608-614
Berkman LF, Macintyre S. The Measurement of Social Class in Health Studies: Old Measures and New Formulations. In: Kogevinas M, Susser M, Boffetta P. editors. Social Inequa-lities and Cancer. Lyon: IARC; 1997. p. 51-64
Macintyre S. Inequalities in Health: Is Research Gender Blind? In: Leon DA, Walt G, editors. Poverty, Inequality, and Health. New York: Oxford University Press; 2001. p. 283-293
Erikson R. Social class of men, women, and families. Sociology 1984; 18(4): 500-514
Bartley M, Sacker A, Firth D, Fitzpatrick R. Social position, social roles and women's health in England: Changing relationships 1984-1993. Soc Sci Med 1999; 48(1): 99-115
Grundy E, Holt G. The socioeconomic status of older adults: How should we measure it in studies of health inequalities? J Epidemiol Community Health 2001; 55(12): 895-904
Kaplan GA, Seeman TE, Cohen RD, Knudsen LP, Guralnik J. Mortality among the elderly in the Alameda County Study: Behavioral and demographic risk factors. Am J Public Health 1987; 77(3): 307-312
Grundy E, Glaser K. Socio-demographic differences in the onset and progression of disability in early old age: A longitudinal study. Age Ageing 2000; 29(2): 149-157
Hu P, Adler NE, Goldman N, Weinstein M, Seeman TE. Relationship between subjective social status and measures of health in older Taiwanese persons. J Am Geriatr Soc 2005; 53(3): 483-488
West P, Macintyre S, Annandale E, Hunt K. Social class and health in youth: Findings from the west of Scotland twenty-07 study. Soc Sci Med 1990; 30(6): 665-673
Currie CE, Elton RA, Todd J, Platt S. Indicators of socioeconomic status for adolescents: The WHO Health Behaviour in School-aged Children Survey. Health Educ Res 1997; 12(3): 385-397
Goodman E, Amick BC, Rezendes MO, Levine S, Kagan J, Rogers WH, Tarlov AR. Adolescents' understanding of social class: A comparison of white upper middle class and working class youth. J Adoiesc Health 2000; 27(2): 80-83
Halldorsson M, Kunst AE, Kohler L, Mackenbach JP. Socioeconomic inequalities in the health of children and adolescents: A comparative study of the five Nordic countries. Eur J Public Health 2000; 10(4): 281-288
Goodman E, Adler NE, Kawachi I, Frazier AL, Huang B, Colditz GA. Adolescents' perceptions of social status: Development and evaluation of a new indicator. Pediatrics serial online 2001; 108(2): E31. [cited 2007 Sep 30]; Available from: URL: http://www.pediatrics.org/cgi/content/full/108/2/e31
Moon OR, Lee KS, Lee KH, Chang DM, Lee HJ, Kim CY, Shin YJ. Distributive Justice in Health Care. Seoul National University Press; 1999. p. 56 (Korean)
Macintyre S, McKay L, Der G, Hiscock R. Socio-economic position and health: What you observe depends on how you measure it. J Public Health Med 2003; 25(4): 288-294
Geyer S, Hemstrom O, Peter R, Vagero D. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health 2006; 60(9): 804-810
Lynch JW, Kaplan GA, Shema SJ. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med 1997; 337(26): 1889-1895
Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med 2003; 56(6): 1321-1333
Macleod J, Davey Smith G, Metcalfe C, Hart C. Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Soc Sci Med 2005; 61(9): 1916-1929
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