Introduction
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To what extent have existing studies examined social inequality, social networks, and health inequality using a single empirical approach?
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What have the findings of these studies revealed about the effects of the structural and the compositional characteristics of social networks on the association between social inequalities and health?
The topic: social networks, health, and social inequalities
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homogeneity and homophily measures of one’s network members (indices of, respectively, the similarity of one’s network partners and their resemblance to oneself);
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measures of the density or redundancy of one’s network (indices that show to what extent a network is or is not loosely knit); or
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the presence and the number of bonding ties (the core network of close contacts) or bridging ties (which provide access to resources and information not available within the core network).
Social networks contain individual relationships of various types and with varying qualities, and can be characterised by: |
1) relational information on relationships and their characteristics (e.g., on ties to relatives, friends, or neighbours; or on contact frequency or emotional closeness); |
2) functional information (e.g., support, influence, conflict); and |
3) structural information (e.g., size, density, homogeneity) |
Methods: reviewing studies using a social network perspective on health inequalities
Identifying relevant studies: data sources and search terms
Search Strategy: publications include at least one term from all three groups |
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1) Health health, illness, disease, disorder, health status, health behavior, health behaviour, risk behavior, risk behaviour, coping, well-being, well-being, life satisfaction, mortality, morbidity, life expectancy, life expectancies, quality of life |
2) Social inequality social status, socioeconomic status, socio-economic status, SES, social class, income, education, occupation, prestige, poverty, financial strain, wealth, low-income, deprivation, inequality, inequalities, disparity, disparities |
3) Social network analysis social network, personal network, egocentered, egocentred, ego-centered, ego-centred, egocentric network, egonet, ego-net, whole network, family network, friendship network, support network, informal network, kinship network, network chart, network size, sociogram |
Selecting studies: article screening and eligibility criteria
Formal criteria: |
duplicate, no journal article, not in English or German language, no empirical paper |
Thematic criteria: |
no focus on general human health (focus on health service use, specific health issues or specific groups), does not report vertical social inequality measures, does not treat personal networks (but instead treats neural networks or computer networks), no regional focus on OECD countries |
Data charting and final extraction
Results: characteristics and main findings of the eligible studies
General characteristics of the final body of studies
Methodological characteristics of the final body of studies
Study design and methodology
Types of health measurements
Types of social inequality measurements
Types of social network measurements
Main findings of included studies on the interconnections between social inequality, social networks, and health inequality
Social networks as moderators of health inequalities (moderator analysis “type 1”)
SES as moderators of network impact on health (moderator analysis “type 2”)
Social networks as mediators of health inequalities
Social networks in multivariate models of health inequalities
Discussion and conclusion
(1) The theoretical bases of the studies differed considerably. Two types of moderator models could be distinguished from mediator and multivariate models |
(2) The mediator and moderator models from Fig. 1 had the highest levels of plausibility and evidence, which provides support for the relevance of social network studies in research on health inequalities |
(3) Social networks appeared to have the strongest effects on health inequalities when (i) they were observed in disadvantaged social contexts or societal strata; and (ii) they were studied in conjunction with health issues that were affected by social resources or capital |
(4) The relevant allocation of social resources and capital to health inequalities was determined by the relational, functional, and structural characteristics of social networks |
Main statistical model | Number of studies that confirm expected effects | Number of studies that do not find effects | Total |
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Moderation type 1 | 4 | 1* | 5 |
Moderation type 2 | 4 | 2 | 6 |
Mediation | 7 | 2* | 9 |
Multivariate analysis | 6 | - | 6 |
Total | 21 | 5 | 26 |