Mediation of the effect of childhood socioeconomic position by educational attainment on adult chronic disease in Chile.
Int J Public Health
; 62(9): 1007-1017, 2017 Dec.
Article
em En
| MEDLINE
| ID: mdl-28656323
OBJECTIVES: We estimated the roles of childhood socioeconomic position (ChSEP) and education attainment on chronic diseases in Chilean adults, mediated through structural determinants and health behaviors, to identify potential pro-equity interventions. METHODS: We analyzed Chile's longitudinal Social Protection Surveys, a national sample of 14,788 adults with follow-up to 2009. Controlled direct effects (CDE) and natural effects (NDE and NIE) of ChSEP and education on number of chronic diseases were estimated with negative binomial models. RESULTS: CDE of low ChSEP with education fixed at 12 years showed a 12% increase with 4% indirect effects. CDEs at favorable levels of BMI, smoking, alcohol use, and physical activity were similar. CDE estimates for education adjusted for ChSEP were larger with negligible mediation. CDEs for women were generally larger. CONCLUSIONS: Low ChSEP exerts a primarily direct effect on later chronic disease, modestly mediated by education. Education attainment showed larger direct effects with minimal mediation by behaviors. Strengthening current-early child development and education policies, particularly gender aspects, may reduce social inequalities and key pathways for reducing chronic disease inequalities in Chile.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Classe Social
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Doença Crônica
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Escolaridade
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Disparidades nos Níveis de Saúde
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Child
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do sul
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Chile
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article