Rachelle Meisters, Jeroen Albers, Bengisu Sezer, Anke Wesselius, Annemarie Koster, Hans Bosma
This study indicates that both residential and work environments contribute to socioeconomic inequalities in SRH and may partially mediate these associations. The findings underscore the need for integrated public health strategies that address structural, systemic determinants of health across multiple life domains. Policy efforts should focus on improving neighborhood infrastructure and workplace conditions to reduce health inequalities and promote health equity.
AIM: This study investigates how residential and work environmental factors are associated with the relationship between socioeconomic position (SEP) and self-rated health (SRH). While previous research has examined these domains separately, this study aims to assess their combined influence and potential mediating role in explaining socioeconomic inequalities in SRH. METHODS: Longitudinal data from The Maastricht study were used, a population-based cohort of 9187 individuals aged 40-75 years in the south of the Netherlands, both within and outside the labor market. Complete cases analyses included 6551 participants. SRH was assessed at baseline and annually over a 12-year follow-up period using the SF-36 questionnaire. SEP was operationalized as a composite score based on education, income and occupational status. Residential environment factors included walkability, green space, food environment, air pollution and social cohesion. Work environment factors included autonomy at work, support at work, psychological and physical job demands. Associations were analyzed using logistic regression, multilevel modelling for repeated measures, and counterfactual mediation analyses, adjusted for age and sex. RESULTS: Respondents with low SEP reported significantly poorer SRH and more adverse residential and work conditions. Longitudinal analyses showed that low SEP was associated with a 0.21-point higher score for poorer SRH (on a scale from 1 to 5) compared to high SEP. Adverse perceived walkability, low social cohesion, and poor working conditions were independently associated with poorer SRH. Lack of autonomy at work, physical job demands, perceived walkability and perceived social cohesion were the strongest mediators, accounting between 6.5% and 12.9% of the association between low SEP and poorer SRH. CONCLUSION: This study indicates that both residential and work environments contribute to socioeconomic inequalities in SRH and may partially mediate these associations. The findings underscore the need for integrated public health strategies that address structural, systemic determinants of health across multiple life domains. Policy efforts should focus on improving neighborhood infrastructure and workplace conditions to reduce health inequalities and promote health equity.