Epidemiol Rev 2004;26:63-77
© 2004 by the Oxford University Press
Socioeconomic Position and Health among Persons with Diabetes Mellitus: A Conceptual Framework and Review of the Literature
1 Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
2 Health Sciences and Research Development, Ann Arbor Veterans Administration Medical Center and University of Michigan, Ann Arbor, MI.
3 Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC.
4 Centers for Disease Control and Prevention, Atlanta, GA.
5 Division of Research, Kaiser Permanente, Oakland, CA.
6 Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
7 Center for Continuing and Outreach Education, Pacific Health Research Institute, Honolulu, HI.
Correspondence to Dr. Arleen F. Brown, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Campus Box 951736, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095-1736 (e-mail: abrown@mednet.ucla.edu).
Received for publication September 16, 2003; accepted for publication December 16, 2003.
Abbreviation: SEP, socioeconomic position.
| The first 150 words of the full text of this article appear below. |
There has been a resurgence of interest in the relation between health and socioeconomic position (SEP). SEP encompasses two important notions: the influence of the structural location of individuals and groups in a society and the cumulative effects of time. It addresses the context in which health-damaging exposures and health-protective resources act at different stages of the life course to influence adult health (1, 2). Such an approach provides a broad framework in which to think about and understand how both recent and remote socioeconomic factors interact to affect adult health. A substantial body of literature demonstrates that in the general population, material and social deprivation are directly related to disease incidence and prevalence and inversely related to health status (1, 3–8). Various studies have addressed the relation between lower SEP and mortality (9) or the development of chronic conditions
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MECHANISMS THROUGH WHICH SEP INFLUENCES HEALTH AMONG PERSONS WITH DIABETES |
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SEP and diabetes outcomes
Proximal mediators/moderators: health behaviors, access, and process
Distal mediators/moderators
Critical covariates
Endogeneity or reverse causality
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EVIDENCE ON THE PROXIMAL PATHWAYS |
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SEP and diabetes outcomes
SEP, health behaviors, and diabetes outcomes
SEP, access to care, and diabetes outcomes
SEP and the process of care
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EVIDENCE ON THE DISTAL PATHWAYS |
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Individual-level pathways between SEP and health for persons with diabetes
Patient and provider communication. Health literacy. Language barriers. Culture and acculturation. Mental health. Social support, social integration, and competing demands. Stress. Provider characteristics
Characteristics of communities or neighborhoods
Availability and accessibility of healthy foods. Access to places to exercise and neighborhood safety. Transportation. Environmental exposures. Health care organizations
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CONCLUSIONS |
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ACKNOWLEDGMENTS |
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