The contribution of lifestyle and work factors to social inequalities in self-rated health among the employed population in Switzerland Oliver H € ammig a, * , Felix Gutzwiller b , Ichiro Kawachi c a Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich 8001, Switzerland b University of Zurich, Seilergraben 53, Zurich 8001, Switzerland c Department of Social and Behavioral Sciences, School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA article info Article history: Received 17 March 2014 Received in revised form 11 July 2014 Accepted 21 September 2014 Available online Keywords: Switzerland Health inequalities Social gradient Educational status Occupational status Lifestyle factors Physical and psychosocial work factors abstract We sought to examine the joint and independent contributions of working conditions and health-related behaviours in explaining social gradients in self-rated health (SRH). Nationally representative cross- sectional data from the Swiss Health Survey of 2007 were used for this study. Bi- and multivariate statistical analyses were carried out on a sample of 6950 adult employees of working age. We examined a comprehensive set of five health behaviours and lifestyle factors as well as twelve physical and psy- chosocial work factors as potential mediators of the relationship between social status and SRH. Analyses were stratified by sex and performed using two measures of social status, educational level and occu- pational position. Strong social gradients were found for SRH, but mainly in men whereas in women the associations were either not linear (educational level) or not statistically significant (occupational po- sition). Social gradients were also found for most lifestyle and all physical and psychosocial work factors studied. These three groups of factors equally contributed to and largely accounted for the social gra- dients in SRH although not all of the individual factors turned out to be independent and significant risk factors for poor SRH. Such risk factors included physical inactivity and obesity, poor posture and no or low social support at work (both sexes), heavy smoking (men) and underweight, overweight, uniform arm or hand movements at work, monotonous work and job insecurity (women). In conclusion, social inequalities (or more precisely educational and occupational status differences) in SRH were more pronounced in men and can be attributed for the most part to a sedentary lifestyle and to a physically demanding and socially unsupportive and insecure work environment. Apart from this main finding and overall pattern, sex-specific risk profiles were observed with regard to SRH and need to be taken into consideration. © 2014 Elsevier Ltd. All rights reserved. 1. Introduction The social gradient in health, disease and mortality is one of the most widely observed and consistent findings in international epidemiological research (Adler et al., 1994; Mackenbach et al., 1997; Mackenbach et al., 2008; Marmot et al., 1997). Despite remarkable declines in morbidity and mortality rates over the past century, social inequalities in health persist e in some cases and countries have been observed to have widened over time (Borg and Kristensen, 2000; Kunst et al., 2005; Kristensen et al., 2002; Mackenbach et al., 2003; Mackenbach, 2012). This inverse and graded relation between social status and mortality (as well as antecedent morbidity) has been consistently found for both educational and occupational status (Marmot et al., 1997) and has been intensively studied with regard to cardiovas- cular disease and self-rated health (Borg and Kristensen, 2000; Borrell et al., 2004; Kunst et al., 2005; McFadden et al., 2008). Numerous population-based prospective studies have revealed that self-ratings of health have predictive validity for subsequent hos- pitalization and mortality risk (DeSalvo et al., 2006; Idler and Benyamini, 1997). Health inequalities research over the past decades has devoted considerable effort toward identifying specific social environ- mental or behavioural factors that explain (or mediate) the rela- tionship between social status and health. Factors that have been studied and identified to account for this link include (Adler et al., * Corresponding author. E-mail address: oliver.haemmig@uzh.ch (O. H€ ammig). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2014.09.041 0277-9536/© 2014 Elsevier Ltd. All rights reserved. Social Science & Medicine 121 (2014) 74e84