Patricia Frenz1, Jay S Kaufman2, Carolina Nazzal3, Gabriel Cavada3, Francisco Cerecera4, Nicolás Silva3. 1. School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile. pfrenz@med.uchile.cl. 2. Canada Research Chair in Health Disparities, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada. 3. School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile. 4. Fondo Nacional de Salud, Departamento de Estudios, Santiago, Chile.
Abstract
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.
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.
Authors: María Elena Alvarado; María Luisa Garmendia; Gonzalo Acuña; Rodrigo Santis; Oscar Arteaga Journal: Rev Med Chil Date: 2010-01-13 Impact factor: 0.553
Authors: Bruna Galobardes; Mary Shaw; Debbie A Lawlor; John W Lynch; George Davey Smith Journal: J Epidemiol Community Health Date: 2006-01 Impact factor: 3.710
Authors: Andrew D A C Smith; Jon Heron; Gita Mishra; Mark S Gilthorpe; Yoav Ben-Shlomo; Kate Tilling Journal: Epidemiology Date: 2015-09 Impact factor: 4.822