A life course approach to measuring socioeconomic position in population surveillance and its role in determining health status.
Date
2009
Authors
Chittleborough, Catherine Ruth
Editors
Advisors
Hiller, Janet Esther
Baum, Frances
Baum, Frances
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Thesis
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Abstract
Measuring socioeconomic position (SEP) in population chronic disease and risk factor
surveillance systems is essential for monitoring changes in socioeconomic inequities in
health over time. A life course approach in epidemiology considers the long-term
effects of physical and social exposures during gestation, childhood, adolescence, and
later adult life on health. Previous studies provide evidence that socioeconomic factors
at different stages of the life course influence current health status. Measures of SEP
during early life to supplement existing indicators of current SEP are required to more
adequately explain the contribution of socioeconomic factors to health status and
monitor health inequities.
The aim of this thesis was to examine how a life course perspective could enhance the
monitoring of SEP in chronic disease and risk factor surveillance systems. The thesis
reviewed indicators of early life SEP used in previous research, determined indicators of
early life SEP that may be useful in South Australian surveillance systems, and
examined the association of SEP over the life course and self-rated health in adulthood
across different population groups to demonstrate that inclusion of indicators of early
life SEP in surveillance systems could allow health inequities to be monitored among
socially mobile and stable groups.
A variety of indicators, such as parents’ education level and occupation, and financial
circumstances and living conditions during childhood, have been used in different study
designs in many countries. Indicators of early life SEP used to monitor trends in the
health and SEP of populations over time, and to analyse long-term effects of policies on
the changing health of populations, need to be feasible to measure retrospectively, and
relevant to the historical, geographical and sociocultural context in which the
surveillance system is operating.
Retrospective recall of various indicators of early life SEP was examined in a telephone
survey of a representative South Australian sample of adults. The highest proportions
of missing data were observed for maternal grandfather’s occupation, and mother’s and
father’s highest education level. Family structure, housing tenure, and family financial
situation when the respondent was aged ten, and mother and father’s main occupation
had lower item non-response. Respondents with missing data on early life SEP
indicators were disadvantaged in terms of current SEP compared to those who provided
this information. The differential response to early life SEP questions according to current circumstances has implications for chronic disease surveillance examining the
life course impact of socioeconomic disadvantage.
While face-to-face surveys are considered the gold standard of interviewing techniques,
computer-assisted telephone interviewing is often preferred for cost and convenience.
Recall of father’s and mother’s highest education level in the telephone survey was
compared to that obtained in a face-to-face interview survey. The proportion of
respondents who provided information about their father’s and mother’s highest
education level was significantly higher in the face-to-face interview than in the
telephone interview. Survey mode, however, did not influence the finding that
respondents with missing data for parents’ education were more likely to be
socioeconomically disadvantaged. Alternative indicators of early life SEP, such as
material and financial circumstances, are likely to be more appropriate than parents’
education for life course analyses of health inequities using surveillance data.
Questions about family financial situation and housing tenure during childhood and
adulthood asked in the cross-sectional telephone survey were used to examine the
association of SEP over the life course with self-rated health in adulthood.
Disadvantaged SEP during both childhood and adulthood and upward social mobility in
financial situation were associated with a reduced prevalence of excellent or very good
health, although this relationship varied across gender, rurality, and country of birth
groups.
Trend data from a chronic disease and risk factor surveillance system indicated that
socioeconomic disadvantage in adulthood was associated with poorer self-rated health.
The surveillance system, however, does not currently contain any measures of early life
SEP. Overlaying the social mobility variables on the surveillance data indicated how
inequities in health could be differentiated in greater detail if early life SEP was
measured in addition to current SEP. Inclusion of life course SEP measures in
surveillance will enable monitoring of health inequities trends among socially mobile
and stable groups.
Life course measures are an innovative way to supplement other SEP indicators in
surveillance systems. Considerable information can be gained with the addition of a
few questions. This will provide further insight into the determinants of health and
illness and enable improved monitoring of the effects of policies and interventions on
health inequities and intergenerational disadvantage.
School/Discipline
School of Population Health and Clinical Practice
Dissertation Note
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2009
Provenance
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.