Hostility and the educational gradient in health. The mediating role of health-related behaviours

BACKGROUND: The aim was to study hostility as a factor intermediate in the association between educational level and health. METHODS: 1997 cross-sectional data from the Dutch GLOBE study (1675 men and 1819 women) was used. The analyses distinguishes between direct effects of hostility on health, and indirect effects, which are through health-related behaviours. The latter indicates that hostile people may be at risk of adverse health, because they engage in unhealthy behaviours. Data were analysed with logistic regression techniques. RESULTS: Among men and women, the odds of less than good health was higher in lower educational groups. A substantial part of the educational gradient in health could be ascribed to the intermediate effects of hostility. Among both men and women, the direct effects of hostility were more important than indirect effects. CONCLUSION: Results suggest that interventions should be aimed at the prevention of the development of hostility. Additionally, interventions aimed at the reduction of health damaging behaviours among adults may lead to a reduction of socio-economic inequalities in health.