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The contribution of material, psychosocial, and behavioral factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: Relative and absolute perspectives

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  • Khang, Young-Ho
  • Lynch, John W.
  • Yang, Seungmi
  • Harper, Sam
  • Yun, Sung-Cheol
  • Jung-Choi, Kyunghee
  • Kim, Hye Ryun

Abstract

The contributions of material, psychosocial, and behavioral factors in explaining socioeconomic inequalities in health have been explored in many Western studies. Most prior investigations have looked at relative abilities to explain such inequalities. In addition, little research focuses on Asian countries, despite the fact that the prevalence and socioeconomic distribution of risk factors for mortality are different there. This study examined relative and absolute abilities of material, psychosocial, and behavioral pathways to explain educational and occupational inequalities in mortality in a nationally representative sample from South Korea. The 1998 and 2001 National Health and Nutrition Examination Survey data were pooled and linked to national mortality data. Of 8366 men and women over 30 years of age, 310 died between 1999 and 2005. Nine pathway variables were examined: three material factors (income, health insurance, and car ownership status), three psychosocial factors (depression, stress, and marital status), and three behavioral factors (smoking, alcohol consumption, and physical exercise). The relative risk and relative index of inequality were used as measures of relative inequality, and risk differences and the slope index of inequality were used as measures of absolute inequality. Material factors explained a total of 29.0% of the excess in relative risk for education and 50.0% of the excess in relative risk for occupational class. Material factors explained 78.6% of the excess in absolute mortality difference for education and 41.1% for occupational class. Psychosocial factors for both education and occupational class had a relative and absolute explanatory power of less than 15%. Behavioral factors showed a relative explanatory power of about 15%, but absolute explanatory power reached 84.0% for education and 105.4% for occupational class. However, the number of deaths used to calculate the absolute explanatory power was small. Results of this study suggest that absolute socioeconomic mortality inequalities could be substantially reduced if behavioral risk factors were reduced in the whole population.

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  • Khang, Young-Ho & Lynch, John W. & Yang, Seungmi & Harper, Sam & Yun, Sung-Cheol & Jung-Choi, Kyunghee & Kim, Hye Ryun, 2009. "The contribution of material, psychosocial, and behavioral factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: Relative an," Social Science & Medicine, Elsevier, vol. 68(5), pages 858-866, March.
    • Handle: RePEc:eee:socmed:v:68:y:2009:i:5:p:858-866
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    1. Schrijvers, C.T.M. & Stronks, K. & Van De Mheen, H.D. & Mackenbach, J.P., 1999. "Explaining educational differences in mortality: The role of behavioral and material factors," American Journal of Public Health, American Public Health Association, vol. 89(4), pages 535-540.
    2. Kivimäki, M. & Lawlor, D.A. & Smith, G.D. & Kouvonen, A. & Virtanen, M. & Elovainio, M. & Vahtera, J., 2007. "Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart Disease: The finnish public sector study," American Journal of Public Health, American Public Health Association, vol. 97(5), pages 874-879.
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    Cited by:

    1. Titus J Galama & Hans van Kippersluis, 2019. "A Theory of Socio-economic Disparities in Health over the Life Cycle," The Economic Journal, Royal Economic Society, vol. 129(617), pages 338-374.
    2. Minhye Kim & Young-Ho Khang & Hee-Yeon Kang & Hwa-Kyung Lim, 2020. "Educational Inequalities in Self-Rated Health in Europe and South Korea," IJERPH, MDPI, vol. 17(12), pages 1-14, June.
    3. repec:dau:papers:123456789/9292 is not listed on IDEAS
    4. Samir KC & Harold Lentzner, 2010. "The effect of education on adult mortality and disability: a global perspective," Vienna Yearbook of Population Research, Vienna Institute of Demography (VID) of the Austrian Academy of Sciences in Vienna, vol. 8(1), pages 201-235.
    5. Hämmig, Oliver & Gutzwiller, Felix & Kawachi, Ichiro, 2014. "The contribution of lifestyle and work factors to social inequalities in self-rated health among the employed population in Switzerland," Social Science & Medicine, Elsevier, vol. 121(C), pages 74-84.
    6. Hwa-Kyung Lim & Young-Ho Khang, 2019. "Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(4), pages 585-594, May.
    7. Sandy Tubeuf & Florence Jusot & Damien Bricard, 2012. "Mediating Role Of Education And Lifestyles In The Relationship Between Early‐Life Conditions And Health: Evidence From The 1958 British Cohort," Health Economics, John Wiley & Sons, Ltd., vol. 21(S1), pages 129-150, June.
    8. Marialaura Bonaccio & Augusto Di Castelnuovo & Simona Costanzo & Mariarosaria Persichillo & Maria Benedetta Donati & Giovanni de Gaetano & Licia Iacoviello, 2016. "Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(7), pages 765-776, September.
    9. Marialaura Bonaccio & Augusto Di Castelnuovo & George Pounis & Amalia De Curtis & Simona Costanzo & Mariarosaria Persichillo & Chiara Cerletti & Maria Benedetta Donati & Giovanni de Gaetano & Licia Ia, 2017. "Relative contribution of health-related behaviours and chronic diseases to the socioeconomic patterning of low-grade inflammation," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(5), pages 551-562, June.
    10. Lantz, Paula M. & Golberstein, Ezra & House, James S. & Morenoff, Jeffrey, 2010. "Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults," Social Science & Medicine, Elsevier, vol. 70(10), pages 1558-1566, May.
    11. Titus J. Galama & Adriana Lleras-Muney & Hans van Kippersluis, 2018. "The Effect of Education on Health and Mortality: A Review of Experimental and Quasi-Experimental Evidence," NBER Working Papers 24225, National Bureau of Economic Research, Inc.
    12. Young-Ho Khang & Hye Kim, 2010. "Self-rated health and mortality: gender- and age-specific contributions of explanatory factors in South Korea," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 55(4), pages 279-289, August.
    13. Cristiano Piccinelli & Paolo Carnà & Silvia Stringhini & Gabriella Sebastiani & Moreno Demaria & Michele Marra & Giuseppe Costa & Angelo d’Errico, 2018. "The contribution of behavioural and metabolic risk factors to socioeconomic inequalities in mortality: the Italian Longitudinal Study," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(3), pages 325-335, April.

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