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Differential exposure and differential vulnerability as two counteracting forces linking the psychosocial work environment to socio-economic health differences
  1. Christophe Vanroelen1,*,
  2. Katia Levecque2,
  3. Fred Louckx1
  1. 1 Department of Medical Sociology, Vrije Universiteit Brussel, Belgium;
  2. 2 Research Foundation Flanders & Department of Sociology, University of Ghent, Belgium
  1. Correspondence to: Christophe Vanroelen, Department of Medical Sociology, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium; cvroelen{at}


Background: In this paper the link between (1) psychosocial working conditions (job demands, job autonomy, task variation, social support), (2) self-reported health (persistent fatigue, musculoskeletal complaints, emotional well-being) and (3) socio-economic position (skill levels, occupational status) is explored. The two theoretical pathways linking the psychosocial work environment to socio-economic differences in health are explored: differential exposure and differential vulnerability. Previously the focus has been often on social inequalities in exposure to the stressors. The pathway of differential vulnerability in different socio-economic positions is often neglected.

Methods: In a representative cross-sectional sample of 11,099 Flemish (Belgian) wage-earners, aged 16-65 years of age (47.5% women), logit modelling is applied.

Results: Higher exposure to psychosocial occupational stressors is associated with a higher prevalence of adverse health outcomes. Lower skill levels and subordinate occupational positions show a higher prevalence of musculoskeletal complaints, but not of persistent fatigue or emotional well-being. High demands, job strain and iso-strain are more common in higher-skilled, supervisory and managerial positions, but have the strongest health-damaging effects in lower-socioeconomic positions. Low control is more prevalent in lower-skilled and subordinate positions, while having stronger adverse health effects in higher socio-economic positions – the same holds for social support, although it has no clear socio-economic distribution.

Conclusion: Differential exposure and differential vulnerability constitute two counteracting forces in constituting the association between the psychosocial work environment and socio-economic differences in self-reported health complaints among wage-earners.

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