СОЦИАЛЬНЫЕ РАЗЛИЧИЯ В СОСТОЯНИИ ЗДОРОВЬЯ РОССИЯН: РОЛЬ МАТЕРИАЛЬНЫХ, ПСИХОСОЦИАЛЬНЫХ И ПОВЕДЕНЧЕСКИХ ФАКТОРОВ

Abstract

Significance. Social inequality in the health status is a major public health challenge. The underlying mechanisms are yet to be well understood. This is especially true for Russia. The purpose of the study is to analyze the association between the social status and self-rated health, as well as to study the contribution of various material, psychosocial and behavioral factors with due regard to their interrelations, to social inequality in the health status in Russia. Material and methods. The study is based on data from the Comprehensive observation of living conditions conducted by the Federal State Statistics Service (Rosstat) in 2018. Social status was measured by the level of education. The direct and indirect contributions of three material, four psychosocial, and two behavioral factors to social differences in self-rated health were studied using logistic regression methods. Results. Given the socio-demographic characteristics, lower levels of education are associated with higher health risks. Out of the three groups of factors, material factors contribute to social inequality the most: the relationship between education and health decreased by 45-48% when material factors were included, with the inclusion of psychosocial factors - by 8-15%, and with behavioral factors included - by 5-13%. Part of the contribution of material factors is associated with psychosocial factors, while the other part - with the behavioral ones. Psychosocial factors contribute to social inequality, in part through behavioral factors. The inclusion of all possible explanatory factors has reduced the association between education and health by 52-62%. The sequential inclusion of individual factors made it possible to establish that such factors as employment, income level, impossibility of meeting with relatives and friends, and alcohol consumption make the main contribution to the explanation of the relationship between health and education. Conclusions. The results highlight the need to address material problems first, especially low incomes and unemployment, which can significantly reduce social inequity in the health status.