Morbidity compression: explanatory approaches

Advances in medical diagnostics and treatment options have a significant influence on the development of morbidity and mortality in the population, but psychosocial and demographic factors are also of central importance in this context. A further aim of the research activities is to shed light on the temporal trends in subjective health and specific illnesses from this medical-sociological perspective.

According to the framework model for explaining socially determined health inequality (Moor et al. 2018), three different causal relationships can be identified for the manifestation of social differences in health opportunities and disease risks. These are

• material or structural causation, which focuses on different living conditions (such as housing and working conditions)
• psychosocial causation, which focuses on social differences in terms of health-related resources and stresses (such as social support and control), and
• behavioral causation, which focuses on health-related lifestyle habits (such as smoking and physical activity).

In the analyses, this conceptual framework is used to explain health trends. The first step is to analyze how the relevant social determinants, e.g. working and living conditions, the extent of social burdens and resources as well as the health-relevant lifestyle have developed over time, i.e. over the last 10 to 20 years. Building on this, the relative importance of these factors for positive and negative trends in subjective health and morbidity and their direct and indirect effects will be examined. Finally, specific interactions and causal assumptions between the social determinants are examined on the basis of theory-based hypotheses in order to take account of the complexity of social factors influencing the dynamic development of health. Both population-based analysis strategies (GEE) and multilevel and mixed-model approaches are used, which combine longitudinal intra-individual processes with temporal trends at population level.

The analyses are intended to provide information on the health consequences associated with the social, economic and demographic developments of recent decades. Particular attention will be paid to how health opportunities have developed in different population groups and to what extent this can be attributed to the causal relationships mentioned above. The information can contribute to the assessment of previous prevention and health promotion measures and inform future decisions on priority prevention areas for the objective of reducing health inequalities.

References:

Moor I, Spallek J, Richter M. Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioral factors. J Epidemiol Community Health 2017;71:565-575.