Article Text
PDF
Abstract
Background Health inequities can stem from socioeconomic position (SEP) leading to poor health (social causation) or poor health resulting in lower SEP (health selection). We aimed to examine the longitudinal bidirectional SEP-health associations and identify inequity risk factors.
Methods Longitudinal Household Israeli Panel survey participants (waves 1–4), age ≥25 years, were included (N=11 461; median follow-up=3 years). Health rated on a 4-point scale was dichotomised as excellent/good and fair/poor. Predictors included SEP parameters (education, income, employment), immigration, language proficiency and population group. Mixed models accounting for survey method and household ties were used.
Results Examining social causation, male sex (adjusted OR 1.4; 95% CI 1.1 to 1.8), being unmarried, Arab minority (OR 2.4; 95% CI 1.6 to 3.7, vs Jewish), immigration (OR 2.5; 95% CI 1.5 to 4.2, reference=native) and less than complete language proficiency (OR 2.22; 95% CI 1.50 to 3.28) were associated with fair/poor health. Higher education and income were protective, with 60% lower odds of subsequently reporting fair/poor health and 50% lower disability likelihood. Accounting for baseline health, higher education and income were associated with lower likelihood of health deterioration, while Arab minority, immigration and limited language proficiency were associated with higher likelihood. Regarding health selection, longitudinal income was lower among participants reporting poor baseline health (85%; 95% CI 73% to 100%, reference=excellent), disability (94%; 95% CI 88% to 100%), limited language proficiency (86%; 95% CI 81% to 91%, reference=full/excellent), being single (91%; 95% CI 87% to 95%, reference=married), or Arab (88%; 95% CI 83% to 92%, reference=Jews/other).
Conclusion Policy aimed at reducing health inequity should address both social causation (language, cultural, economic and social barriers to good health) and health selection (protecting income during illness and disability).
- HEALTH
- Health inequalities
- SOCIAL CLASS
Data availability statement
Data are available on reasonable request. This study comprised data from the first four waves (2012, 2013, 2014–2015, 2016) of the Longitudinal Household Panel Survey led by the Israeli Central Bureau of Statistics (ICBS). Deidentified data are publicly available from the ICBS.
Statistics from Altmetric.com
Data availability statement
Data are available on reasonable request. This study comprised data from the first four waves (2012, 2013, 2014–2015, 2016) of the Longitudinal Household Panel Survey led by the Israeli Central Bureau of Statistics (ICBS). Deidentified data are publicly available from the ICBS.
Footnotes
Contributors All authors contributed to the study conception, design and planning. MB and OK-L were responsible for data acquisition and design of the analysis database. MB created the analysis database. LSF, RF and HM provided statistical support and prepared the statistical analysis plan. MB and RF performed the statistical analysis. All authors contributed to data interpretation. The first draft was written by MB, and all authors commented on previous versions of the manuscript and critically reviewed and approved the final version. MB
is the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding Aaron Institute for Economic Policy, Reichman University, Herzliya, Israel 2019.04.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.