Health disparities by occupation, modified by education: a cross-sectional population study.
BACKGROUND
Socio-economic disparities in health status are frequently reported in research. By comparison with education and income, occupational status has been less extensively studied in relation to health status or the occurrence of specific chronic diseases. The aim of this study was to investigate health disparities in the working population based on occupational position and how they were modified by education.


METHODS
Our data were derived from the National Survey of General Practice that comprised 104 practices in the Netherlands. 136,189 working people aged 25-64 participated in the study. Occupational position was assessed by the International Socio-Economic Index of occupational position (ISEI). Health outcomes were self-perceived health status and physician-diagnosed diseases. Odds ratios were estimated using multivariate logistic regression analysis.


RESULTS
The lowest occupational position was observed to be associated with poor health in men (OR = 1.6, 95% CI 1,5 to 1.7) and women (OR = 1.3, 95% CI 1.2 to 1.4). The risk of poor health gradually decreased in relation to higher occupational positions. People with the lowest occupational positions were more likely to suffer from depression, diabetes, ischaemic heart disease, arthritis, muscle pain, neck and back pain and tension headache, in comparison to people with the highest occupational position (OR 1.2 to 1.6). A lower educational level induced an additional risk of poor health and disease. We found that gender modified the effects on poor health when both occupational position and education were combined in the analysis.


CONCLUSIONS
A low occupational position was consistently associated working people with poor health and physician-diagnosed morbidity. However a low educational level was not. Occupational position and education had a combined effect on self-perceived health, which supports the recent call to improve the conceptual framework of health disparities.
Volkers
Anita C
AC
NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands. a.volkers@nivel.nl
Westert
Gert P
GP
Schellevis
Francois G
FG
D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D016272:Occupational Health; D009790:Occupations / Q000145:classification*; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class