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The explanation for the observed social gradient in morbidity and mortality is a subject of controversy. Whereas some authors emphasise the importance of psychosocial factors related with health,1 because they show a linear relation with individual socioeconomic status, others postulate that health inequalities are produced as a result of a differential accumulation of exposures and experiences that have their origin in objective material conditions.2
This debate is focused principally on chronic diseases, thus infectious diseases are implicitly excluded. Furthermore, the mechanisms by which these diseases produce inequalities are assumed to be well understood because of their strong association with absolute poverty3: material conditions related to absolute poverty would increase exposure to comunicable diseases and would reduce resistence to infection. Because these assumptions have not been evaluated, even though their confirmation would be important in supporting one or the other of the theories mentioned, in this study we analyse the relation between …
Funding: this study was supported by a grant from the Consejería de Educación de la Comunidad de Madrid (no 06/0092/1999) and by a grant from the Fondo de Investigaciones Sanitarias (no 00/0514/1999).
Conflicts of interest: none.